Acid Gone Extra Strength
23 June, 2023
Adapalene
23 June, 2023
Actoplus Met XR
Generic name:
Pioglitazone hydrochloride and metformin hydrochloride extended-release
Drug class:
Thiazolidinedione and biguanide combination; antidiabetic agent
Dosage form:
Extended-release tablets
Root of administration:
Oral
Dose:
Initial: pioglitazone 15 mg/metformin XR 500 mg once daily with meals; titrate to maintenance of 15–45 mg pioglitazone with 500–2000 mg metformin XR once daily, based on glycemic response and tolerability
Mechanism of action:
Pioglitazone activates peroxisome proliferator-activated receptor gamma (PPARγ) to enhance insulin sensitivity; metformin decreases hepatic gluconeogenesis and improves peripheral glucose uptake
Drug usage cases:
- Type 2 diabetes mellitus
- Polycystic ovary syndrome (off-label)
- Nonalcoholic steatohepatitis (off-label)
Drug contra indications:
- Hypersensitivity to pioglitazone, metformin, or any component
- NYHA Class III or IV heart failure
- Diabetic ketoacidosis
- Severe renal impairment (eGFR <30 mL/min/1.73 m²)
- Acute or chronic metabolic acidosis, including lactic acidosis
- Known liver disease or hepatic dysfunction
- Use of iodinated contrast agents in radiologic studies
Side effects:
- Gastrointestinal disturbances: diarrhea, nausea, vomiting, abdominal discomfort
- Edema and fluid retention
- Weight gain
- Upper respiratory tract infections
- Headache
- Hypoglycemia when combined with insulin or secretagogues
- Lactic acidosis (rare but serious)
- Exacerbation of heart failure
- Bone fractures in women
- Increased risk of bladder cancer (pioglitazone)
- Vitamin B12 deficiency with long-term metformin use
Warnings:
- Risk of lactic acidosis; monitor renal function and discontinue in conditions predisposing to hypoxia
- Monitor for signs of heart failure; use caution in patients with cardiovascular risk
- Hepatic monitoring due to potential hepatotoxicity
- Increased risk of bone fractures; caution in patients with osteoporosis
- Potential macular edema
- Possible bladder cancer risk; assess patient history
- Use with caution in elderly patients
Use during pregnancy or breastfeeding:
Pioglitazone is pregnancy category C and crosses the placenta; use only if benefit justifies risk. Metformin is category B and crosses the placenta. Both are excreted in breast milk; breastfeeding is not recommended without medical supervision.
