Generic Name: metformin and pioglitazone (met FOR min and PYE o GLI ta zone)
Brand Names: Actoplus Met, Actoplus Met XR
What is metformin and pioglitazone?
Metformin and pioglitazone is a combination of two oral diabetes medicines that help control blood sugar levels.
Metformin and pioglitazone is for people with type 2 diabetes who do not use daily insulin injections. This medication is not for treating type 1 diabetes.
Metformin and pioglitazone may also be used for purposes not listed in this medication guide.
What is the most important information I should know about metformin and pioglitazone?
You should not use this medication if you are allergic to metformin (Glucophage) or pioglitazone (Actos), or if you have kidney problems, severe heart failure, active bladder cancer, or metabolic acidosis. Do not use metformin and pioglitazone if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). Do not take this medicine for longer than recommended. Taking pioglitazone for longer than 1 year (12 months) may increase your risk of developing bladder cancer. Talk with your doctor about your specific risk.
If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and pioglitazone.
Before taking metformin and pioglitazone, tell your doctor if you have congestive heart failure or heart disease, a history of bladder cancer, a history of heart attack or stroke, liver disease, eye problems caused by diabetes, or if you are 80 years or older.
Some people develop lactic acidosis while taking metformin. Early symptoms may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.
What should I discuss with my healthcare provider before taking metformin and pioglitazone?
Some people develop a life-threatening condition called lactic acidosis while taking metformin and pioglitazone. You may be more likely to develop lactic acidosis if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your individual risk. Do not use metformin and pioglitazone if you have kidney disease, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin). You should not use this medication if you are allergic to metformin (Glucophage) or pioglitazone (Actos), or if you have:
kidney problems;
severe heart failure;
active bladder cancer; or
metabolic acidosis.
If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and pioglitazone. Be sure your caregivers know ahead of time that you are using this medication.
To make sure you can safely take metformin and pioglitazone, tell your doctor if you have any of these other conditions:
congestive heart failure or heart disease, or a history of heart attack or stroke;
liver disease;
a history of bladder cancer;
eye problems caused by diabetes; or
if you are 80 years or older.
Certain oral diabetes medications may increase your risk of serious heart problems. However, not treating your diabetes can damage your heart and other organs. Talk to your doctor about the risks and benefits of treating your diabetes. Some women using metformin and pioglitazone have started having menstrual periods, even after not having a period for a long time due to a medical condition. You may be able to get pregnant if your periods restart. Talk with your doctor about the need for birth control. Women may also be more likely than men to have bone fractures in the upper arm, hand, or foot while taking this medication. Talk with your doctor if you are concerned about this possibility. Do not take this medicine for longer than recommended. Taking pioglitazone for longer than 1 year (12 months) may increase your risk of developing bladder cancer. Talk with your doctor about your specific risk. FDA pregnancy category C. It is not known whether metformin and pioglitazone will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether metformin and pioglitazone passes into breast milk or if it could harm a nursing baby. You should not breast-feed while taking this medication.
How should I take metformin and pioglitazone?
Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Take metformin and pioglitazone with meals. Take the extended-release (XR) tablet once daily with your evening meal. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.
Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office. Visit your doctor regularly. Check your blood sugar carefully during a time of stress or illness, if you travel, exercise more than usual, drink alcohol, or skip meals. These things can affect your glucose levels and your dose needs may also change.
Know the signs of low blood sugar (hypoglycemia) and how to recognize them: headache, hunger, weakness, sweating, tremors, irritability, or trouble concentrating.
Your doctor may want you to stop taking metformin and pioglitazone for a short time if you become ill, have a fever or infection, or if you have surgery or a medical emergency.
Ask your doctor how to adjust your dose if needed. Do not change your medication dose or schedule without your doctor's advice.
If you take extra vitamin B12 while you are taking metformin and pioglitazone, take only the amount of vitamin B12 that your doctor has prescribed.
Store at room temperature away from moisture and heat.
See also: Metformin and pioglitazone dosage (in more detail)
What happens if I miss a dose?
Take the missed dose as soon as you remember (be sure to take the medicine with food). Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
What should I avoid while taking metformin and pioglitazone?
Avoid drinking alcohol. It can lower your blood sugar and may increase your risk of lactic acidosis.
Metformin and pioglitazone side effects
This medication may cause lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get emergency medical help if you have even mild symptoms of lactic acidosis, such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or irregular heart rate, dizziness, or feeling very weak or tired. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any other serious side effects, such as:
stomach pain, blood in your urine, painful urination;
feeling short of breath, especially when lying down;
swelling or rapid weight gain;
pale skin, feeling light-headed, rapid heart rate, trouble concentrating;
sudden unusual pain in your hand, arm, or foot; or
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).
Less serious side effects may include:
headache;
diarrhea, upset stomach; or
sneezing, runny nose, cough or other signs of a cold.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Metformin and pioglitazone Dosing Information
Usual Adult Dose for Diabetes Mellitus Type II:
metformin-pioglitazone immediate-release:
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.
metformin-pioglitazone extended-release:
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).
What other drugs will affect metformin and pioglitazone?
Tell your doctor about all other medicines you use, especially:
bosentan (Tracleer);
delavirdine (Rescriptor);
digoxin (Lanoxin);
gemfibrozil (Lopid);
morphine (MS Contin, Kadian, Oramorph);
tolbutamide (Orinase);
trimethoprim (Proloprim, Primsol, Bactrim, Cotrim, Septra);
vancomycin (Vancocin, Lyphocin);
amiloride (Midamor), furosemide (Lasix), or triamterene (Dyrenium);
cimetidine (Tagamet) or ranitidine (Zantac);
fluconazole (Diflucan) or ketoconazole (Nizoral);
nicardipine (Cardene) or nifedipine (Nifedical, Procardia);
procainamide (Procan, Pronestyl, Procanbid), quinidine (Quin-G), or quinine (Qualaquin);
rifampin (Rifater, Rifadin, Rifamate) or rifapentine (Priftin);
a non-steroidal anti-inflammatory drug (NSAID) such as flurbiprofen (Ansaid), ibuprofen (Advil, Motrin), indomethacin (Indocin), mefenamic acid (Ponstel), or piroxicam (Feldene); or
seizure medication such as carbamazepine (Carbatrol, Tegretal), phenytoin (Dilantin), phenobarbital (Solfoton), primidone (Mysoline), and others.
You may be more likely to have hyperglycemia (high blood sugar) if you take metformin and pioglitazone with other drugs that can raise blood sugar, such as:
isoniazid;
diuretics (water pills);
steroids (prednisone and others);
heart or blood pressure medication (Cartia, Cardizem, Covera, Isoptin, Verelan, and others);
niacin (Advicor, Niaspan, Niacor, Simcor, Slo-Niacin, and others);
phenothiazines (Compazine and others);
thyroid medicine (Synthroid and others);
birth control pills and other hormones;
seizure medicines (Dilantin and others); and
diet pills or medicines to treat asthma, colds or allergies.
These lists are not complete and there are many other medicines that can increase or decrease the effects of metformin and pioglitazone on lowering your blood sugar. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More metformin and pioglitazone resources
- Metformin and pioglitazone Side Effects (in more detail)
- Metformin and pioglitazone Dosage
- Metformin and pioglitazone Use in Pregnancy & Breastfeeding
- Metformin and pioglitazone Drug Interactions
- Metformin and pioglitazone Support Group
- 6 Reviews for Metformin and pioglitazone - Add your own review/rating
Compare metformin and pioglitazone with other medications
- Diabetes, Type 2
Where can I get more information?
- Your pharmacist can provide more information about metformin and pioglitazone.
See also: metformin and pioglitazone side effects (in more detail)
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