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This medicine is used in the management of type 2 diabetes particularly in overweight patients.

Some patients might experience visual disturbance and Respiratory infection. Please consult your doctor if you experience any of these symtpoms

Please consult your doctor before taking this medicine if you have any of these conditions; hepatic impairment, cardiac failure or history of cardiac failure.

This medicine should be taken with food.

Avoid this medication if:

  • You are allergic to this medicine or its contents.

Consult your doctor if:

  • You are pregnant, planning to have a child, or breastfeeding.
  • You have any sort of digestive problems
  • You have a medical history of: Liver diseases, kidney diseases, heart diseases, or bladder cancers.
  • Inform your physician about any other medication you are taking.
  • You experience weakness in your bones
  • You experience breathing difficulties (due to swelling in the lungs)

Be careful about:

  • Having your meals on time to maintain blood sugar levels
  • Taking the medicine timely, in the way that your physician has prescribed.
  • Weight gain, as it is a possible side effect of this medicine.

 

Type II diabetes

This medicine is indicated in maturity onset diabetes either alone or with sulphonylureas. It is also used as adjuvant therapy in insulin dependent diabetes, particularly in obese patients.

GI upset, taste disturbance, abnormal liver function tests, hepatitis (inflammatory condition of liver), skin reactions, reduced B12 absorption are some of its side effects. Rarely it may cause lactic acidosis (buildup of lactate causing acidic pH of blood stream).

This medicine is contraindicated in patients with diabetic ketoacidosis (life threatening condition in which liver breaks down fats into ketones for energy) or precoma (a state of near unconsciousness), renal (kidney) or hepatic (liver) impairment, acute conditions predisposing to renal impairment, cardiac or respiratory failure, recent myocardial infarction (heart attack), alcoholism and in patients with administration of iodinated contrast materials.

This medicine should be taken with food.

Avoid this medication if:

  • You are allergic to this medicine or its contents 

Consult your doctor if:

  • You are pregnant, planning to have a child, or breastfeeding.
  • If you are avoiding unwanted pregnancy, so that your doctor may suggest a suitable form of birth control. Due to Metformin's effects on ovulation and pregnancy.
  • You have any sort of digestive problems after taking this medicine: Nausea, vomiting, diarrhea, etc.
  • You have a medical history of: Liver diseases, kidney diseases, congestive heart failure, or lung disease.
  • If you are about to undergo any medical or surgical treatment. 
  • If you are about to undergo any CT scan, or X-ray, as it may interact with the dyes used in some pf these procedures.
  • If you have a B12 deficiency, are anemic, or are developing symptoms of anemia, Such as: lethargy, aches and pains,  or a pale appearance to the skin. 

Be careful about:

  • Having your meals on time to maintain blood sugar levels.
  • Taking the medicine timely, in the way that your physician has prescribed (with food), this will help avoid digestive disturbances.
  • Alcohol consumption.
  • Avoiding dehydration in any form.
Type II diabetes
It belongs to a class of drugs known as glitazones, or thiazolidinediones
This is a possible side effect, but can be avoided if meals are taken regularly. Try to carry sugar or a sugary drink in case you experience lightheadedness, or any other symptoms of low blood sugar.
You can take the missed dose as soon as you remember. If you remember when it is almost time for your next dose, then skip the missed dose entirely. Do not double your dose to catch up for missed doses.
If you are not regular with your meals, you may experience symptoms of low blood sugar: Such as palpitation, sweating, dizziness, light headedness etc. In this case, taking sugar can relieve your symptoms.
Using this drug may cause edema (swelling) of the ankles. It may also cause swelling in the lungs, which may lead to breathlessness.
Can this drug be used in the treatment of Poly Cystic Ovarian Disease?
Metformin belongs to a class of drugs known as biguanides. It is used to improve insulin activity, and control weight in diabetic patients. It is also known to regulate menstrual cycles (periods) and is used in the treatment of PCOs (Poly Cystic Ovarian Disease.)
No, this drug does not contain hormones, or insulin,. It enhances the effect of insulin, which helps patients with diabetes or PCOs, since their bodies tend to develop a resistance to the actions of insulin.
Though there is no dangerous drug interaction, an adjustment in doses of both anti thyroid drugs, and steroids (eg: prednisone) may be required. It should be noted that patients taking steroids sometimes develop diabetes as a side effect. Please consult your physician, and discuss all the medicines you are taking, including their doses.
Lactic acidosis is a very rare, and potentially fatal side effect of this medication. It occurs when there is an excessive buildup of lactic acid in the body. It may occur in patients who have overdosed. Symptoms include stomach problems, dizziness, breathing difficulty, muscle aches, irregular heartbeat, etc. Patients who experience these symptoms should go to a doctor immediately.
Please use this medicine for the time that has been prescribed, and in the dose prescribed by your physician. Using it for longer than prescribed can cause side effects such as Vitamin B12 deficiency.
Low blood sugar is rare with Metformin, but it is a possible side effect, especially if you are taking other anti-diabetic drugs. Please maintain regularity in meals, dosage, and exercise to maintain blood sugar levels, and continue monitoring sugar levels. Also carry sugar or a sugary drink in case you feel dizzy, or develop any other sign of low blood sugar.
You can take the missed dose as soon as you remember. If you remember when it is almost time for your next dose, then skip the missed dose entirely. Do not double your dose to catch up for missed doses.
It is important to maintain regularity in meals, and exercise. Low blood sugar is rare, but may occur if you are taking other anti-diabetic medication.
Weight gain is unlikely with this medicine, however, it does cause weight loss. This is because it improves the actions of insulin, and decreases hunger. Please take note that this drug is not a medicine which treats weight loss, and should only be used if prescribed by your physician. This medicine may, however, cause bloating. It is best taken after meals to avoid this side effect.
This medication can result in a vitamin B12 deficiency after being used for a long time, and this can cause anemia. Please discuss with your doctor if you are already anemic, or if you start experiencing symptoms such as paleness, weakness, lethargy, etc.
In patients who have fatty liver, and hepatitis C related liver disease, it is safe and is recommended. However, it is discouraged in patients who have liver cirrhosis, due to its association with lactic acidosis.
Please consult your doctor before taking this medicne.
Research suggests that this medicine should be avoided by women who are breastfeeding.
Please avoid driving when taking this medicine as it may affect your ability to drive.
Please avoid consuming alcohol when taking this medicine.
Regular monitoring for cardiac failure is important.
This medicine is safe to use in pregnant females. No evidence of risk found. 
This medicine is contraindicated in lactating females.
Please avoid consuming alcohol when taking this medicine.
Assess risk factors for lactic acidosis (buildup of lactate causing acidic pH of blood stream). Discontinue immediately if metabolic acidosis (overproduction of acid in the body) is suspected. Monitor renal (kidney) function at least annually. Discontinue the medicine for 48 hours before and after the elective surgery. 

Pioglitazone + Metformin

Indication

It is indicated for treating Diabetes Mellitus type 2 as monotherapy or with metformin.

Dosage

Strength: 15mg/500mg

Form: tablet

Dosing interval: Once a day.

Maximum Dose: It is suggested to not to exceed 45mg/2550mg per day.

Dialyzable:Metformin: Yes

Maintainance dose

The dose recommendation for pioglitazone alone therapy is to start with 15-30mg per day with metformin. If metformin alone therapy: start with 1000-1700mg per day with pioglitazone.

Hepatic Adjustment

Study shows that: 1) If ALT (alanine transferase) levels are lesser than 2.5 x Upper limit number, the medicine needs to be used with caution. 2) If ALT (alanine transferase) levels are greater or equal to 2.5 x Upper limit number, Do not use the medicine. 3) If f ALT (alanine transferase) levels are greater than 3 x Upper limit number or patient is reported with jaundice; Discontinuation of medicine is recommended.

Renal Adjustment

In patients with eGFR (glomerular filteration rate) less than 30ml/min/1.73m2; the medicine is contraindicated. However, in patients eGFR (glomerular filteration rate) approximately 30-45ml/min/1.73m2; the drug is not suggested to be used for therapeutic indication.

  • pregnant

    Pregnancy

    Can be used but doctor consultation is important before use, as human and animal research is insufficient or animals showed defects and human research hasn?t been conducted.

  • mother

    Lactation

    Studies suggested the use of this combination therapy should not be used by nursing mothers as many adverse effects were reported in animal studies which weighs out the potential risk for lactating mothers. Choice should be made upon either to stop the use of medication or stop nursing.

ContraIndication
Cautions

BLACK BOX WARNING: Pioglitazone and Rosiglitazone are known to cause an exaggeration of cardiovascular cases. Studies recommend to conduct Liver enzyme tests before initiating therapy, with eGFR (estimated Glomerular filteration rate) less than 30ml/min/1.73m2 monitor with extreme care. Elderly patients of age greater than 80 years requires special monitoring when on metformin=pioglitazone therapy. Monitor levels of vitamin B12 and glucose levels when initiating the therapy. Unexpected ovulation may occur in premenopausal women is also reported when taking this combinational therapy. Study also reported an evidence of fluid retention in patients using insulin in combination. Lactic acidosis evidences have also been reported.

Pharmacokinetics

Disclaimer

Dawaai's intention is to make sure that it's consumers get information that is accurate, reviewed by an expert and error-free. However, the information mentioned here should not be used as a replacement for the advice of a qualified physician. The information given here is for informational purposes only, which may not cover all possible precautions, side effects, contraindications or drug interactions. Consult your doctor and discuss your queries related to any medicine or disease.

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