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Precautions and Warnings With Pioglitazone and Metformin

Specific Precautions and Warnings With Pioglitazone and Metformin

Some precautions and warnings to be aware of prior to taking pioglitazone and metformin include the following:
 
  • Studies suggest that pioglitazone (one of the active ingredients in this medication) may increase the risk of bladder cancer, particularly in people who have taken the medication for one year or longer. You should not take this medication if you have bladder cancer. Additionally, this medication should be used very cautiously in people who have had bladder cancer in the past.

  

  • Pioglitazone and metformin can cause fluid retention (known medically as edema). For most people, this is not dangerous. However, fluid retention can be serious in people with congestive heart failure (CHF). It is possible for fluid retention to lead to heart failure, even in people who have no history of heart failure or any other heart disease. There may be an increased risk of edema or heart failure for people taking both pioglitazone and metformin and insulin. Contact your healthcare provider if you notice:
 
 
  • Very rarely, metformin (one of the active ingredients of pioglitazone and metformin) can cause a life-threatening condition called lactic acidosis. Your risk of lactic acidosis increases with other medical conditions, including:
 
    • Congestive heart failure (CHF)
    • Kidney failure
    • Liver problems, including liver failure and cirrhosis.
(Click Metformin and Lactic Acidosis for more information, including possible symptoms.) 
  • Drinking alcohol can increase your risk of lactic acidosis. Drinking large amounts of alcohol on a regular basis or drinking a large amount of alcohol at once (binge drinking) should be avoided while taking pioglitazone and metformin (see Metformin and Alcohol).
     
  • Since liver disease (including liver failure and cirrhosis) can increase your risk of developing lactic acidosis, you should not take pioglitazone and metformin if your liver is not functioning normally. Also, your kidney function needs to be monitored while you are taking pioglitazone and metformin. This means that you should have blood tests that check your kidneys before you start the drug and then again at least once every year. If your kidney function is poor, you should not take pioglitazone and metformin due to increased risk of lactic acidosis.
     
  • Taking metformin (one of the active ingredients in pioglitazone and metformin) and contrast dye at the same time can increase your risk of kidney damage. Contrast dye is used for certain radiology procedures, including some x-rays, CT scans, and heart catheterizations (see Metformin and Contrast Medium). Also, pioglitazone and metformin should be temporarily stopped for most major surgeries and restarted when you are eating normally again.
     
  • Fever, infections, injury, or surgery can temporarily increase your blood sugar, even in people with well-controlled diabetes. Pioglitazone and metformin may not be enough to treat your diabetes at these times, and the use of insulin may be required. Contact your healthcare provider if you have a fever, infection, injury, or will be having surgery. Also, make sure you know the symptoms of high blood sugar and how to check your blood sugar levels (see Actoplus Met and Blood Sugar).
     
  • Let your healthcare provider know if you have an illness that causes severe vomiting, diarrhea, or fever, or if you drink a much lower amount of liquid than normal. These conditions can lead to severe dehydration (loss of water in your body). You may need to stop taking pioglitazone and metformin for a short time if this occurs.
     
  • Pioglitazone and metformin can decrease your levels of vitamin B12. Your healthcare provider should monitor your vitamin B12 levels, especially if you have a vitamin B12 deficiency (including pernicious anemia).
     
  • There have been reports of pioglitazone and metformin causing macular edema (a condition of the eye). Tell your healthcare provider if you have any vision changes.
     
  • If you are a premenopausal woman who has infertility problems due to lack of ovulation, pioglitazone and metformin may increase your chance of ovulation (and pregnancy). Talk to your healthcare provider about birth control options if you would like to avoid pregnancy while taking pioglitazone and metformin.
     
  • Pioglitazone and metformin may cause increased liver enzymes. Very rarely, this has led to liver damage. It is recommended that liver enzymes be checked in all people before starting pioglitazone and metformin and then checked again periodically. Liver enzymes are checked using a simple blood test. Pioglitazone and metformin should not be started in people with high liver enzymes. The drug should be stopped if liver enzymes increase and continue to stay high, as this may be a sign of liver damage.
     
  • Pioglitazone and metformin can cause weight gain. In studies, people taking medications similar to pioglitazone and metformin gained up to four pounds on average (see Actoplus Met and Weight Gain). Talk to your healthcare provider about rapid weight gain, as this may be a sign of fluid retention.
     
  • Pioglitazone and metformin can interact with certain medications (see Drug Interactions With Pioglitazone and Metformin).
     
  • Pioglitazone and metformin is considered a pregnancy Category C medication. This means that the drug may not be safe to use during pregnancy. Talk to your healthcare provider about the risks and benefits of using pioglitazone and metformin during pregnancy (see Actoplus Met and Pregnancy).
     
  • It is not known if pioglitazone and metformin passes through breast milk. Therefore, if you are breastfeeding or plan to start breastfeeding, be sure to talk with your healthcare provider about this.
     
  • In rare cases, pioglitazone and metformin can cause low blood sugar (hypoglycemia), usually when it is combined with other diabetes drugs. This has been more common in elderly people and in people with adrenal, pituitary, liver, or kidney problems. It is also more likely to occur during fasting before surgery and after prolonged exercise. Low blood sugar symptoms may include irritability, trembling, cold sweats, or blurry vision, among other things.
     
7 Signs of High Blood Sugar

Pioglitazone and Metformin (Actoplus Met)

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