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Metformin and Pioglitazone Brand Names- Actoplus Met | Actoplus Met XR
What is Metformin and Pioglitazone
Metformin and pioglitazone is a combination product containing 2 antidiabetic agents. The product is used as an adjunct to diet and exercise, to lower blood glucose levels in adults with type 2 diabetes mellitus (DM).
Metformin is a biguanide agent that improves insulin sensitivity. While metformin carries a low risk for lactic acidosis as outlined in the prescribing information and boxed warning of all metformin-containing products, care in prescribing and monitoring can reduce this risk.
Pioglitazone is a member of the thiazolidinedione (TZD) class. Pioglitazone has been shown to reduce some cardiovascular endpoints, but without conclusive evidence of benefit.
The TZDs, including pioglitazone, cause or exacerbate congestive heart failure in some patients and are contraindicated in those with established NYHA Class III or IV heart failure.
Metformin is first-line in the treatment of type 2 DM. In patients with established cardiovascular (CV) disease, HF, or chronic kidney disease (CKD), a sodium-glucose co-transporter 2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with proven CV benefit and reduction of CKD progression is recommended for add-on therapy, independent of baseline A1C or individualized A1C target.
In patients without indicators of high-risk or established CVD, HF, or CKD, pioglitazone and other TZDs are a therapeutic option associated with glycemic durability; however, the benefits must be balanced with the risk of adverse effects such as heart failure, edema, reduced bone mineral density, and weight gain.
In patients who are starting on insulin therapy and are taking pioglitazone, discontinue or reduce the dose of pioglitazone.
Hypoglycemia, fluid retention, and edema are most common when pioglitazone is used in combination with insulin. Pioglitazone may be used with insulin as long as the insulin dose is carefully titrated to glycemic response.
Although not FDA-approved, the TZDs and metformin may prevent future development of diabetes in 60% to 75% and 25% to 30% of subjects with prediabetes, respectively
Indications
- type 2 diabetes mellitus
For the treatment of type 2 diabetes mellitus not controlled by diet and exercise
for use when either metformin or pioglitazone alone is inadequate
Side Effects
- abdominal pain
- anemia
- anorexia
- blurred vision
- bone fractures
- cholestasis
- diarrhea
- dizziness
- dysgeusia
- dyspepsia
- dyspnea
- edema
- elevated hepatic enzymes
- flatulence
- fluid retention
- folate deficiency
- headache
- heart failure
- hepatic encephalopathy
- hepatic failure
- hepatitis
- hyperbilirubinemia
- hypoglycemia
- infection
- jaundice
- lactic acidosis
- macular edema
- malaise
- megaloblastic anemia
- menstrual irregularity
- metabolic acidosis
- metallic taste
- myalgia
- nausea
- new primary malignancy
- osteopenia
- peripheral edema
- pharyngitis
- rhabdomyolysis
- sinusitis
- visual impairment
- vitamin B12 deficiency
- weight gain
Monitoring Parameters
- blood glucose
- CBC
- glycosylated hemoglobin A1c (HbA1c)
- LFTs
- serum bilirubin
- serum creatinine/BUN
- weight
Contraindications
- acidemia
- acute heart failure
- acute myocardial infarction
- adrenal insufficiency
- alcoholism
- anemia
- bladder cancer
- bone fractures
- breast-feeding
- burns
- cardiac disease
- cardiogenic shock
- children
- contraception requirements
- dehydration
- diabetic ketoacidosis
- diarrhea
- edema
- ethanol ingestion
- ethanol intoxication
- fever
- gastroparesis
- geriatric
- GI obstruction
- heart failure
- hepatic disease
- hypercortisolism
- hyperglycemia
- hyperthyroidism
- hypoglycemia
- hypothyroidism
- hypoxemia
- ileus
- infection
- lactic acidosis
- malnutrition
- menstrual irregularity
- metabolic acidosis
- new primary malignancy
- osteoporosis
- peripheral edema
- pernicious anemia
- pituitary insufficiency
- polycystic ovary syndrome
- pregnancy
- pulmonary edema
- radiographic contrast administration
- renal disease
- renal failure
- renal impairment
- sepsis
- surgery
- trauma
- type 1 diabetes mellitus
- vomiting
Interactions
- Abacavir; Dolutegravir; Lamivudine
- Abacavir; Lamivudine, 3TC
- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Abiraterone
- Acebutolol
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Propoxyphene
- Acetaminophen; Pseudoephedrine
- Acetazolamide
- Acetohexamide
- Acrivastine; Pseudoephedrine
- Adefovir
- Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
- Aliskiren; Hydrochlorothiazide, HCTZ
- Aliskiren; Valsartan
- Amiloride; Hydrochlorothiazide, HCTZ
- Amlodipine; Atorvastatin
- Amlodipine; Benazepril
- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Amphetamine
- Amphetamine; Dextroamphetamine
- Amphetamines
- Amprenavir
- Androgens
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Aripiprazole
- Asenapine
- Atazanavir
- Atazanavir; Cobicistat
- Atenolol
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- Atorvastatin
- Atorvastatin; Ezetimibe
- Atropine; Hyoscyamine; Phenobarbital; Scopolamine
- atypical antipsychotic
- Azelastine; Fluticasone
- Azilsartan
- Azilsartan; Chlorthalidone
- Beclomethasone
- Belladonna Alkaloids; Ergotamine; Phenobarbital
- Benazepril
- Benazepril; Hydrochlorothiazide, HCTZ
- Bendroflumethiazide; Nadolol
- Benzphetamine
- Beta-blockers
- Betamethasone
- Betaxolol
- Bexarotene
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- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Bortezomib
- Brexpiprazole
- Brigatinib
- Brimonidine; Timolol
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Dextromethorphan; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Budesonide
- Budesonide; Formoterol
- Bumetanide
- Candesartan
- Candesartan; Hydrochlorothiazide, HCTZ
- Cannabidiol
- Capmatinib
- Captopril
- Captopril; Hydrochlorothiazide, HCTZ
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Cariprazine
- Carteolol
- Carvedilol
- Cephalexin
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chloroquine
- Chlorothiazide
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Chlorpropamide
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- Dexamethasone
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- Dextroamphetamine
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- Donepezil; Memantine
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- Dorzolamide; Timolol
- Drospirenone
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- Drospirenone; Ethinyl Estradiol
- Drospirenone; Ethinyl Estradiol; Levomefolate
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- Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
- Elagolix; Estradiol; Norethindrone acetate
- Elbasvir; Grazoprevir
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
- Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
- Emtricitabine
- Emtricitabine; Rilpivirine; Tenofovir alafenamide
- Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
- Emtricitabine; Tenofovir alafenamide
- Emtricitabine; Tenofovir disoproxil fumarate
- Enalapril, Enalaprilat
- Enalapril; Felodipine
- Enalapril; Hydrochlorothiazide, HCTZ
- Entecavir
- Ephedrine
- Eprosartan
- Eprosartan; Hydrochlorothiazide, HCTZ
- Erdafitinib
- Erythromycin; Sulfisoxazole
- Esmolol
- Esterified Estrogens
- Esterified Estrogens; Methyltestosterone
- Estradiol
- Estradiol Cypionate; Medroxyprogesterone
- Estradiol; Levonorgestrel
- Estradiol; Norethindrone
- Estradiol; Norgestimate
- Estradiol; Progesterone
- Estramustine
- Estrogens
- Estropipate
- Ethacrynic Acid
- Ethanol
- Ethinyl Estradiol
- Ethinyl Estradiol; Desogestrel
- Ethinyl Estradiol; Ethynodiol Diacetate
- Ethinyl Estradiol; Etonogestrel
- Ethinyl Estradiol; Levonorgestrel
- Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
- Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
- Ethinyl Estradiol; Norelgestromin
- Ethinyl Estradiol; Norethindrone
- Ethinyl Estradiol; Norethindrone Acetate
- Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
- Ethinyl Estradiol; Norethindrone; Ferrous fumarate
- Ethinyl Estradiol; Norgestimate
- Ethinyl Estradiol; Norgestrel
- Ethotoin
- Etonogestrel
- Famotidine
- Famotidine; Ibuprofen
- Fenofibrate
- Fenofibric Acid
- Fexofenadine
- Fexofenadine; Pseudoephedrine
- Fibric acid derivatives
- Fludrocortisone
- Flunisolide
- Fluoxetine
- Fluoxetine; Olanzapine
- Fluoxymesterone
- Fluticasone
- Fluticasone; Salmeterol
- Fluticasone; Umeclidinium; Vilanterol
- Fluticasone; Vilanterol
- Formoterol; Mometasone
- Fosamprenavir
- Fosinopril
- Fosinopril; Hydrochlorothiazide, HCTZ
- Fosphenytoin
- Furosemide
- Gadoterate meglumine
- Garlic, Allium sativum
- Gemfibrozil
- Glecaprevir; Pibrentasvir
- Glimepiride
- Glimepiride; Pioglitazone
- Glimepiride; Rosiglitazone
- Glipizide
- Glipizide; Metformin
- Glyburide
- Glyburide; Metformin
- Glycopyrrolate
- Glycopyrrolate; Formoterol
- Green Tea
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Hydantoins
- Hydralazine; Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ
- Hydrochlorothiazide, HCTZ; Irbesartan
- Hydrochlorothiazide, HCTZ; Lisinopril
- Hydrochlorothiazide, HCTZ; Losartan
- Hydrochlorothiazide, HCTZ; Methyldopa
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Moexipril
- Hydrochlorothiazide, HCTZ; Olmesartan
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrochlorothiazide, HCTZ; Quinapril
- Hydrochlorothiazide, HCTZ; Spironolactone
- Hydrochlorothiazide, HCTZ; Telmisartan
- Hydrochlorothiazide, HCTZ; Triamterene
- Hydrochlorothiazide, HCTZ; Valsartan
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Hydrocortisone
- Hydroxychloroquine
- Hydroxyprogesterone
- Ibuprofen; Pseudoephedrine
- Iloperidone
- Indacaterol; Glycopyrrolate
- Indapamide
- Indinavir
- Insulin Aspart
- Insulin Aspart; Insulin Aspart Protamine
- Insulin Degludec
- Insulin Degludec; Liraglutide
- Insulin Detemir
- Insulin Glargine
- Insulin Glargine; Lixisenatide
- Insulin Glulisine
- Insulin Lispro
- Insulin Lispro; Insulin Lispro Protamine
- Insulin, Inhaled
- Insulins
- Iodipamide Meglumine
- Ionic Contrast Media
- Ioxaglate Meglumine; Ioxaglate Sodium
- Irbesartan
- Isocarboxazid
- Isoniazid, INH; Pyrazinamide, PZA; Rifampin
- Isoniazid, INH; Rifampin
- Isophane Insulin (NPH)
- Itraconazole
- Ketoconazole
- Labetalol
- Lamivudine, 3TC
- Lamivudine, 3TC; Zidovudine, ZDV
- Lamivudine; Tenofovir Disoproxil Fumarate
- Lamotrigine
- Lanreotide
- Ledipasvir; Sofosbuvir
- Leflunomide
- Lente Insulin
- Letermovir
- Leuprolide; Norethindrone
- Levobetaxolol
- Levobunolol
- Levomefolate
- Levonorgestrel
- Levothyroxine
- Levothyroxine; Liothyronine (Porcine)
- Levothyroxine; Liothyronine (Synthetic)
- Linezolid
- Liothyronine
- Lisdexamfetamine
- Lisinopril
- Lithium
- Lomefloxacin
- Lopinavir; Ritonavir
- Loratadine; Pseudoephedrine
- Lorcaserin
- Losartan
- Lovastatin; Niacin
- Lumateperone
- Lurasidone
- Mecasermin rinfabate
- Mecasermin, Recombinant, rh-IGF-1
- Medroxyprogesterone
- Meglitinides
- Memantine
- Mestranol; Norethindrone
- Metformin; Repaglinide
- Methamphetamine
- Methazolamide
- Methyclothiazide
- Methylprednisolone
- Methyltestosterone
- Metolazone
- Metoprolol
- Metyrapone
- Midazolam
- Midodrine
- Moexipril
- Mometasone
- Monoamine oxidase inhibitors
- Nadolol
- Nandrolone Decanoate
- Naproxen; Pseudoephedrine
- Nateglinide
- Nebivolol
- Nebivolol; Valsartan
- Nelfinavir
- Niacin, Niacinamide
- Niacin; Simvastatin
- Nicotine
- Nifedipine
- Non-Ionic Contrast Media
- Norethindrone
- Norgestrel
- Octreotide
- Olanzapine
- Olmesartan
- Ombitasvir; Paritaprevir; Ritonavir
- Orlistat
- Oxandrolone
- Oxymetholone
- Paliperidone
- Pasireotide
- Pegvisomant
- Penbutolol
- Pentamidine
- Pentoxifylline
- Perindopril
- Perindopril; Amlodipine
- Phenelzine
- Phenobarbital
- Phenothiazines
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Phenytoin
- Pindolol
- Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
- Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
- Prednisolone
- Prednisone
- Pregabalin
- Progesterone
- Progestins
- Propantheline
- Propoxyphene
- Propranolol
- Protease inhibitors
- Pseudoephedrine
- Pyrimethamine; Sulfadoxine
- Quetiapine
- Quinapril
- Quinolones
- Ramipril
- Ranitidine
- Ranolazine
- Regular Insulin
- Regular Insulin; Isophane Insulin (NPH)
- Repaglinide
- Reserpine
- Rifampin
- Risperidone
- Ritonavir
- Sacubitril; Valsartan
- Salicylates
- Saquinavir
- Segesterone Acetate; Ethinyl Estradiol
- Sofosbuvir
- Sofosbuvir; Velpatasvir
- Sofosbuvir; Velpatasvir; Voxilaprevir
- Somatropin, rh-GH
- Sotalol
- Sparfloxacin
- Sulfadiazine
- Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
- Sulfasalazine
- Sulfisoxazole
- Sulfonamides
- Sulfonylureas
- Sympathomimetics
- Tacrolimus
- Tafenoquine
- Tegaserod
- Telmisartan
- Tenofovir Alafenamide
- Tenofovir, PMPA
- Teriflunomide
- Testolactone
- Testosterone
- Thiazide diuretics
- Thyroid hormones
- Timolol
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- tobacco
- Tolazamide
- Tolbutamide
- Topiramate
- Torsemide
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- Triamterene
- Trimethoprim
- Trospium
- Ultralente Insulin
- Valsartan
- Vandetanib
- Zafirlukast
- Ziprasidone
- Zonisamide
