This dosage information may not include all the information needed to use Metformin/Pioglitazone safely and effectively. See additional information for Metformin/Pioglitazone.
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Usual Adult Dose for:
Additional dosage information:
Usual Adult Dose for Diabetes Mellitus Type II
The usual starting dose is 500 mg-15 mg or 850 mg-15 mg administered once or twice daily with food to reduce the gastrointestinal side effects associated with metformin. The maximal total daily dose of is 2550 mg-45 mg. This maximal dosage should be administered in divided doses with meals.
The usual starting dose is 1000 mg-15 mg or 1000 mg-30 mg administered once daily with the evening meal. The maximal total daily dose is 2000 mg-45 mg administered once daily with the evening meal.
For patients already taking metformin or pioglitazone the initial dosages are based on the current doses of pioglitazone and/or metformin, the dosage of metformin-pioglitazone immediate-release:
For patients inadequately controlled on metformin monotherapy: 15 to 30 mg of pioglitazone (total daily dose) plus the dose of metformin already being taken (metformin-pioglitazone 500 mg-15 mg or 850 mg-15 mg once or twice daily).
For patients inadequately controlled on pioglitazone monotherapy: 1000 mg of metformin (total daily dose) plus the dose of pioglitazone already being taken (metformin-pioglitazone 500 mg-15 mg twice daily or 850 mg-15 mg once daily).
Renal Dose Adjustments
Metformin-pioglitazone is contraindicated in patients with renal disease or dysfunction as suggested by serum creatinine levels greater than or equal to 1.5 mg/dL for males; greater than or equal to 1.4 mg/dL for females or abnormal creatinine clearance.
Liver Dose Adjustments
Therapy with metformin-pioglitazone should not be initiated if the patient exhibits clinical evidence of active liver disease or increased serum transaminase levels (ALT greater than 2.5 times the upper limit of normal).
The initiation and maintenance dosing of metformin-pioglitazone should be conservative in patients with advanced age, due to the potential for decreased renal function in the population. Monitoring of renal function is necessary to aid in the prevention of metformin associated lactic acidosis. Metformin treatment should not be initiated in patients 80 or more years of age unless measurement of creatinine clearance demonstrates that renal function is not reduced. Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).
Metformin is contraindicated in patients with renal failure. Metformin may be removed from the system following prolonged hemodialysis. Venovenous hemofiltration has been used successfully following metformin overdose.
The US FDA requires a Risk Evaluation and Mitigation Strategy (REMS) for metformin-pioglitazone. It includes a Medication Guide. Additional information is available at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm111350.htm.
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