Pioglitazone and metformin (Oral)
met-FOR-min hye-droe-KLOR-ide, pye-oh-GLI-ta-zone hye-droe-KLOR-ide
May cause or worsen congestive heart failure, is not recommended in patients with symptomatic heart failure, and is contraindicated in patients with established NYHA Class III or IV heart failure. Monitor patients for signs and symptoms of heart failure after initiation or dose increases and if heart failure occurs, consider dose reduction or discontinuing metformin/pioglitazone (immediate and extended-release formulations) and manage according to current standards of care. Lactic acidosis can occur due to metformin accumulation during treatment with metformin/pioglitazone (immediate and extended-release formulations) and may result in death, hypothermia, hypotension, and resistant bradyarrhythmias; risk factors include renal impairment, concomitant carbonic anhydrase inhibitor use (eg, topiramate), age 65 years or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (eg, acute congestive heart failure), excessive alcohol intake, and hepatic impairment. Onset is often subtle with nonspecific symptoms such as malaise, myalgias, respiratory distress, somnolence, and abdominal pain; laboratory abnormalities include elevated blood lactate (greater than 5 mmol/L), anion gap acidosis (without ketonuria or ketonemia), increased lactate:pyruvate ratio, and metformin levels generally greater than 5 mcg/mL. If acidosis is suspected, discontinue treatment, hospitalize the patient immediately, and promptly initiate hemodialysis .
Medically reviewed on June 7, 2018
Commonly used brand name(s)
In the U.S.
- Actoplus Met
- Actoplus Met XR
Available Dosage Forms:
- Tablet, Extended Release
Therapeutic Class: Hypoglycemic
Chemical Class: Metformin
Uses For pioglitazone and metformin
Pioglitazone and metformin combination is used with proper diet and exercise to treat high blood sugar levels caused by type 2 diabetes. Pioglitazone works by helping 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. Pioglitazone and metformin does not help patients who have insulin-dependent or type 1 diabetes.
Pioglitazone and metformin is available only with your doctor's prescription.
Before Using pioglitazone 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 pioglitazone and metformin, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to pioglitazone 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.
Appropriate studies have not been performed on the relationship of age to the effects of pioglitazone and metformin combination in the pediatric population. Use is not recommended in children. Safety and efficacy have not been established.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of pioglitazone 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 pioglitazone and metformin combination.
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 pioglitazone 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 pioglitazone 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
- Ethiodized Oil
- Iobenzamic Acid
- Iocarmic Acid
- Iocetamic Acid
- Iodohippuric Acid
- Iodoxamic Acid
- Ioglicic Acid
- Ioglycamic Acid
- Iopanoic Acid
- Iopronic Acid
- Ioseric Acid
- Iotroxic Acid
- Ioxitalamic Acid
- Metrizoic Acid
- Tyropanoate Sodium
Using pioglitazone 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.
- Insulin Aspart, Recombinant
- Insulin Bovine
- Insulin Degludec
- Insulin Detemir
- Insulin Glargine, Recombinant
- Insulin Glulisine
- Insulin Lispro, Recombinant
- Thioctic Acid
Using pioglitazone 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.
- Bitter Melon
- Guar Gum
- Methylene Blue
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 pioglitazone and metformin. Make sure you tell your doctor if you have any other medical problems, especially:
- Adrenal gland problem (underactive) or
- Alcohol abuse, history of or
- Cardiovascular collapse (shock) or
- Congestive heart failure, acute or unstable or
- Dehydration, severe or
- Heart attack, acute or
- Kidney problems or
- Liver disease 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 swelling) or
- Heart disease or
- Liver disease or
- Vitamin B12 deficiency—Use with caution. May make these conditions worse.
- Bladder cancer, active or
- Diabetic ketoacidosis (high ketones and acid in the blood) or
- Heart failure, severe or
- Kidney disease, severe or
- Liver disease, active or
- Metabolic acidosis (acid in the blood) or
- Type I 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.
Proper Use of pioglitazone and metformin
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. Exercise regularly and test for sugar in your blood or urine as directed.
Pioglitazone and metformin should come with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.
Pioglitazone and metformin should be taken with meals to help reduce the unwanted stomach effects that may occur during the first few weeks.
Swallow the medicine whole. Do not crush, break, or chew it.
Part of the extended-release tablet may pass into your stool (bowel movement). This is normal and nothing to worry about.
The dose of pioglitazone 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 pioglitazone 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 type 2 diabetes:
- For oral dosage form (extended-release tablets):
- Adults—At first, 1 tablet one or two times a day with food. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 45 milligrams (mg) of pioglitazone and 2000 mg of metformin per day.
- Children—Use and dose must be determined by your doctor.
- For oral dosage form (tablets):
- Adults—At first, 1 tablet one or two times a day with food. Your doctor may adjust your dose as needed and tolerated. However, the dose is usually not more than 45 milligrams (mg) of pioglitazone and 2550 mg of metformin per day.
- Children—Use and dose must be determined by your doctor.
- For oral dosage form (extended-release tablets):
If you miss a dose of pioglitazone 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.
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 pioglitazone and metformin
It is very important that your doctor check your progress at regular visits to make sure that pioglitazone and metformin is working properly and to decide if you should continue to use it. Blood and urine tests may be needed to check for unwanted effects.
If you are rapidly gaining weight, 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 heart problems or fluid retention (too much water in the body).
Let your doctor or dentist know you are taking pioglitazone and metformin. Your doctor may advise you to stop taking pioglitazone 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.
Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Check with your doctor right away if blurred vision, decreased vision, or any other change in vision occurs while you are taking pioglitazone and metformin. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
Pioglitazone 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.
Pioglitazone and metformin may increase your risk for bladder cancer if you take it for more than 12 months. Tell your doctor right away if you have blood in the urine, a frequent, strong, or increased urge to urinate, painful urination, or pain in the back, lower abdomen, or stomach.
Pioglitazone 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 or take certain medicines. Low blood sugar must be treated before it causes you to pass out (unconsciousness). People feel different symptoms with low blood sugar. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat low blood sugar.
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. High blood sugar can be very serious and must be treated right away. It is important that you learn which symptoms you have in order to treat it quickly. Talk to your doctor about the best way to treat high blood sugar.
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 you have diabetes with a list of all your medicines.
Pioglitazone and metformin may cause some women who do not have regular monthly periods to ovulate. This can increase the chance of pregnancy. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.
Limit how much alcohol you drink while using pioglitazone and metformin. Heavy alcohol use can increase your risk for lactic acidosis.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Pioglitazone 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:
- Bladder pain
- bloody or cloudy urine
- difficult, burning, or painful urination
- frequent urge to urinate
- lower back or side pain
- swelling of the face, fingers, feet, or lower legs
- weight gain
- Pain or swelling in the arms or legs without any injury
- pale skin
- troubled breathing with exertion
- unusual bleeding or bruising
- unusual tiredness or weakness
- blurred vision
- cold sweats
- cool, pale skin
- decreased appetite
- fast heartbeat
- fast, shallow breathing
- general feeling of discomfort
- increased hunger
- loss of consciousness
- muscle pain or cramping
- slurred speech
- stomach discomfort
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:
- Body aches or pain
- ear congestion
- loss of voice
- runny or stuffy nose
- sore throat
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)
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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