Pioglitazone + metformin

Generic Medicine Info
Current or history of cardiac failure (New York Heart Association stage I to IV), active or history of bladder cancer, uninvestigated macroscopic haematuria; type 1 DM, diabetic ketoacidosis or diabetic pre-coma; acute or chronic disease which may cause tissue hypoxia (e.g. cardiac or resp failure, recent MI, shock); conditions which may alter renal function (e.g. dehydration, severe infection, shock). Acute alcohol intoxication. Hepatic or renal impairment (CrCl <60 mL/min). Lactation. Intravascular admin of iodinated contrast agents.
Special Precautions
Patient w/ oedema, anaemia. Premenopausal, anovulatory women. Pregnancy. Patient Counselling This drug may cause visual disturbance, if affected, do not drive or operate machinery. Monitoring Parameters Monitor HbA1c, serum glucose; signs and symptoms of oedema or heart failure, bladder cancer; liver enzymes, haematologic parameters, renal function; vit B12 and folate if anaemia is present. Routine ophth examination.
Adverse Reactions
Oedema, wt gain, hypoglycaemia, macular oedema, bone fractures, anaemia, upper resp infection, headache, diarrhoea, nausea, UTI, sinusitis.
Potentially Fatal: Lactic acidosis, CHF, bladder cancer, hepatic failure.
Drug Interactions
May impair vit B12 absorption. Increased plasma levels w/ strong CYP2C8 inhibitors (e.g. gemfibrozil). Decreased plasma levels w/ CYP2C8 inducers (e.g. rifampicin). Reduced metabolism w/ cationic drugs eliminated by renal tubular secretion.
CIMS Class
Antidiabetic Agents
ATC Classification
A10BG03 - pioglitazone ; Belongs to the class of thiazolidinediones. Used in the treatment of diabetes.
A10BA02 - metformin ; Belongs to the class of biguanides. Used in the treatment of diabetes.
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