rosiglitazone and metformin (Oral route)

met-FOR-min hye-droe-KLOR-ide, roe-zi-GLI-ta-zone MAL-ee-ate

Oral route(Tablet)

Thiazolidinediones, including rosiglitazone, may cause or worsen congestive heart failure in some patients, Use in patients with established NYHA class III or IV heart failure is contraindicated and use in patients with symptomatic heart failure is not recommended. Monitor patients for signs and symptoms of heart failure after initiation or dose increases. If heart failure occurs, consider reducing dose or discontinuing rosiglitazone therapy and manage patient according to current standards of care. Lactic acidosis can occur due to metformin accumulation. The risk of lactic acidosis increases with conditions such as sepsis, dehydration, excess alcohol intake, hepatic insufficiency, renal impairment, and acute congestive heart failure. Symptoms include malaise, myalgias, respiratory distress, increasing somnolence, and nonspecific abdominal distress. Laboratory abnormalities include low pH, increased anion gap, and elevated blood lactate. If acidosis is suspected, immediately discontinue therapy and hospitalize patient .

Commonly used brand name(s)

In the U.S.

  • Avandamet

Available Dosage Forms:

  • Tablet

Therapeutic Class: Hypoglycemic

Chemical Class: Metformin

Uses For rosiglitazone and metformin

Rosiglitazone and metformin combination is used to treat a type of diabetes mellitus called type 2 diabetes. It is used together with a proper diet and exercise to help control blood sugar levels.

Slideshow: Prediabetes - Am I at Risk?

Rosiglitazone helps your body use insulin better. Metformin reduces the absorption of sugar from the stomach, reduces the release of stored sugar from the liver, and helps your body use sugar better.

rosiglitazone and metformin is available only with your doctor's prescription.

Before Using rosiglitazone and metformin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For rosiglitazone and metformin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to rosiglitazone and metformin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of rosiglitazone and metformin combination in the pediatric population. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of rosiglitazone and metformin combination in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving rosiglitazone and metformin combination.

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking rosiglitazone and metformin, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using rosiglitazone and metformin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Acetrizoic Acid
  • Diatrizoate
  • Ethiodized Oil
  • Iobenzamic Acid
  • Iobitridol
  • Iocarmic Acid
  • Iocetamic Acid
  • Iodamide
  • Iodipamide
  • Iodixanol
  • Iodohippuric Acid
  • Iodopyracet
  • Iodoxamic Acid
  • Ioglicic Acid
  • Ioglycamic Acid
  • Iohexol
  • Iomeprol
  • Iopamidol
  • Iopanoic Acid
  • Iopentol
  • Iophendylate
  • Iopromide
  • Iopronic Acid
  • Ioseric Acid
  • Iosimide
  • Iotasul
  • Iothalamate
  • Iotrolan
  • Iotroxic Acid
  • Ioversol
  • Ioxaglate
  • Ioxitalamic Acid
  • Ipodate
  • Metrizamide
  • Metrizoic Acid
  • Tyropanoate Sodium

Using rosiglitazone and metformin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Abiraterone Acetate
  • Acetazolamide
  • Alatrofloxacin
  • Balofloxacin
  • Ceritinib
  • Cimetidine
  • Ciprofloxacin
  • Clinafloxacin
  • Dabrafenib
  • Dichlorphenamide
  • Dofetilide
  • Dolutegravir
  • Enoxacin
  • Fleroxacin
  • Flumequine
  • Gatifloxacin
  • Gemifloxacin
  • Grepafloxacin
  • Insulin Aspart, Recombinant
  • Insulin Degludec
  • Insulin Detemir
  • Insulin Glulisine
  • Insulin Human Inhaled
  • Insulin Human Isophane (NPH)
  • Insulin Human Regular
  • Insulin Lispro, Recombinant
  • Levofloxacin
  • Lomefloxacin
  • Moxifloxacin
  • Nitisinone
  • Norfloxacin
  • Ofloxacin
  • Pefloxacin
  • Pixantrone
  • Prulifloxacin
  • Rufloxacin
  • Sparfloxacin
  • Temafloxacin
  • Tosufloxacin
  • Trovafloxacin Mesylate
  • Vandetanib
  • Zonisamide

Using rosiglitazone and metformin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Alprenolol
  • Atenolol
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bitter Melon
  • Bucindolol
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Cephalexin
  • Colesevelam
  • Dilevalol
  • Enalaprilat
  • Enalapril Maleate
  • Esmolol
  • Fenofibrate
  • Fenugreek
  • Gemfibrozil
  • Glucomannan
  • Guar Gum
  • Iproniazid
  • Isocarboxazid
  • Labetalol
  • Levobunolol
  • Linezolid
  • Mepindolol
  • Methylene Blue
  • Metipranolol
  • Metoprolol
  • Moclobemide
  • Nadolol
  • Nebivolol
  • Nialamide
  • Oxprenolol
  • Penbutolol
  • Phenelzine
  • Pindolol
  • Procarbazine
  • Propranolol
  • Psyllium
  • Ranolazine
  • Rasagiline
  • Rifampin
  • Selegiline
  • Sotalol
  • Talinolol
  • Tertatolol
  • Timolol
  • Tranylcypromine
  • Trimethoprim
  • Trospium

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of rosiglitazone and metformin. Make sure you tell your doctor if you have any other medical problems, especially:

  • Adrenal gland problem (underactive) or
  • Dehydration, severe or
  • Pituitary gland problem (underactive) or
  • Poorly nourished condition or
  • Sepsis (severe infection) or
  • Weakened physical condition—Use with caution. May cause side effects to become worse.
  • Anemia (low red blood cells) or
  • Diabetic macular edema (swelling of the back of the eye) or
  • Edema (fluid retention or body swelling) or
  • Heart attack, history of or
  • Heart disease, history of or
  • Vitamin B12 deficiency—Use with caution. May make these conditions worse.
  • Angina, severe and acute or
  • Diabetic ketoacidosis (high ketones in the blood) or
  • Heart attack, acute or
  • Heart failure, severe or with symptoms or
  • Kidney disease
  • Liver disease
  • Metabolic acidosis (acid in the blood) or
  • Type 1 diabetes—Should not be used in patients with these conditions.
  • Fever or
  • Infection or
  • Surgery or
  • Trauma—Use with caution. These conditions may cause problems with blood sugar control.
  • Fragile bones (especially in women)—Use with caution. rosiglitazone and metformin may increase the risk for fractures.

Proper Use of rosiglitazone and metformin

Use rosiglitazone and metformin only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered.

rosiglitazone and metformin should come with a Medication Guide. It is very important that you read and understand this information. Ask your doctor if you have any questions.

rosiglitazone and metformin should be taken with meals to help reduce the unwanted stomach effects that may occur during the first few weeks.

Carefully follow the special diet your doctor gave you. This is the most important part of controlling your diabetes and will help the medicine work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

Dosing

The dose of rosiglitazone and metformin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of rosiglitazone and metformin. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For type 2 diabetes:
      • For patients inadequately controlled on diet and exercise:
        • Adults—At first, rosiglitazone 2 milligrams (mg) plus metformin 500 mg once or two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than rosiglitazone 8 mg plus metformin 2000 mg per day, divided into two doses.
        • Children—Use and dose must be determined by your doctor.
      • For patients on metformin therapy:
        • Adults—rosiglitazone 4 milligrams (mg) per day plus the dose of metformin already being taken, divided into two doses. Your doctor may adjust your dose as needed.
        • Children—Use and dose must be determined by your doctor.
      • For patients on rosiglitazone therapy:
        • Adults—metformin 1000 milligrams (mg) per day plus the dose of rosiglitazone already being taken, divided into two doses. Your doctor may adjust your dose as needed.
        • Children—Use and dose must be determined by your doctor.
      • For patients not on metformin or rosiglitazone therapy:
        • Adults—rosiglitazone 2 milligrams (mg) plus metformin 500 mg once a day or two times a day as directed by your doctor. Your doctor may adjust your dose as needed. However, the dose is usually not more than rosiglitazone 8 mg plus metformin 2000 mg per day, divided into two doses.
        • Children—Use and dose must be determined by your doctor.
      • For patients previously treated with rosiglitazone and metformin:
        • Adults—The dose is the same as the dose you are already taking. Your doctor may adjust your dose as needed.
        • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of rosiglitazone and metformin, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using rosiglitazone and metformin

It is very important that your doctor check your progress at regular visits to make sure that rosiglitazone and metformin is working properly. Blood and urine tests may be needed to check for unwanted effects.

Call your doctor right away if you have chest pain or discomfort, nausea, pain or discomfort in the arms, jaw, back, or neck, shortness of breath, sweating, or vomiting. These may be symptoms of a heart attack.

If you are rapidly gaining weight or having shortness of breath, chest pain or discomfort, extreme tiredness or weakness, irregular breathing, irregular heartbeat, or excessive swelling of the hands, wrist, ankles, or feet, check with your doctor right away. These may be symptoms of a heart problem or edema (fluid retention).

Let your doctor or dentist know you are taking rosiglitazone and metformin. Your doctor may advise you to stop taking rosiglitazone and metformin before you have major surgery or diagnostic tests, especially tests that use a contrast dye.

Under certain conditions, too much metformin can cause a serious condition called lactic acidosis. The symptoms of lactic acidosis are severe and appear quickly. Lactic acidosis usually occurs when other serious health problems are present, such as a heart attack or kidney failure. The symptoms of lactic acidosis include: abdominal or stomach discomfort, decreased appetite, diarrhea, fast or shallow breathing, a general feeling of discomfort, muscle pain or cramping, and unusual sleepiness, tiredness, or weakness. If you have more than one of these symptoms together, you should get immediate emergency medical help.

If you have abdominal or stomach pain, dark urine, a loss of appetite, nausea or vomiting, unusual tiredness or weakness, or yellow eyes or skin, check with your doctor right away. These may be symptoms of a serious liver problem.

Check with your doctor right away if blurred vision, difficulty in reading, or any other change in vision occurs while you are taking rosiglitazone and metformin. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).

Certain women may be at an increased risk for pregnancy while taking rosiglitazone and metformin. If you had problems ovulating and had irregular periods in the past, rosiglitazone and metformin may cause you to ovulate. This could increase your chance of becoming pregnant. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.

rosiglitazone and metformin may increase the risk for bone fractures in women. Ask your doctor about ways to keep your bones strong to help prevent fractures.

Make sure any doctor or dentist who treats you knows that you are using rosiglitazone and metformin. rosiglitazone and metformin may affect the results of certain medical tests.

It is very important to follow carefully any instructions from your doctor about:

  • Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your doctor.
  • Other medicines—Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
  • Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy.
  • Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
  • In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
  • Symptoms of fluid retention—Know what to do if you start to retain fluid. Fluid retention may worsen or lead to heart problems.

rosiglitazone and metformin can cause hypoglycemia (low blood sugar). Low blood sugar can also occur if you delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting. The symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly.

  • Symptoms of low blood sugar include anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty in thinking, drowsiness, excessive hunger, fast heartbeat, headache (continuing), nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, or unusual tiredness or weakness.
  • If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or drink fruit juice, non-diet soft drinks, or sugar dissolved in water. Also, check your blood for low blood sugar. Glucagon is used in emergency situations when severe symptoms such as seizures (convulsions) or unconsciousness occur. Have a glucagon kit available, along with a syringe or needle, and know how to use it. Members of your family also should know how to use it.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

  • Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination (frequency and amount), ketones in the urine, loss of appetite, sleepiness, stomachache, nausea, or vomiting, tiredness, troubled breathing (rapid and deep), unconsciousness, or unusual thirst.
  • If the symptoms of high blood sugar occur, check your blood sugar level and call your doctor for instructions.

rosiglitazone and metformin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Pale skin
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Less common
  • Anxiety
  • blurred vision
  • chest pain or discomfort
  • chills
  • cold sweats
  • coma
  • confusion
  • cool, pale skin
  • depression
  • dilated neck veins
  • dizziness
  • extreme fatigue
  • fast heartbeat
  • headache
  • increased hunger
  • irregular breathing
  • irregular heartbeat
  • nausea
  • nightmares
  • seizures
  • shakiness
  • slurred speech
  • swelling of the face, fingers, feet, or lower legs
  • weight gain
Rare
  • Abdominal or stomach discomfort
  • decreased appetite
  • diarrhea
  • fast, shallow breathing
  • general feeling of discomfort
  • muscle pain or cramping
  • sleepiness
Incidence not known
  • Change in vision
  • dark urine
  • decreased urine output
  • hives or welts, itching, or skin rash
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • pain or discomfort in the arms, jaw, back, or neck
  • redness of the skin
  • stomach pain
  • sweating
  • vomiting

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Body aches or pain
  • cough, fever, sneezing, or sore throat
  • difficulty with breathing
  • ear congestion
  • loss of voice
  • pain or tenderness around the eyes and cheekbones
  • stuffy or runny nose
Less common
  • Back pain
  • cold or flu-like symptoms
  • difficulty with moving
  • pain in the joints

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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