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Pioglitazone/metformin, sold under the brand nameActoplus Met among others, is afixed-dose combinationanti-diabetic medication used to improveglycemic control in adults withtype 2 diabetes.^[3][2] It containspioglitazone, athiazolidinedione, andmetformin, abiguanide.^[2]

• Pioglitazone is a member of thethiazolidinedione class, it decreasesinsulin resistance in the periphery and in the liver resulting in increased insulin dependent glucose disposal and decreased hepatic glucose output.^{[medical citation needed]}
• Metformin is a member of thebiguanide class, improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization.^{[medical citation needed]}

Pioglitazone/metformin is indicated as an adjunct to diet and exercise:^{[medical citation needed]}

• To improve glycemic control in patients with type 2 diabetes, or
• For patients who are already treated with a separate combination of pioglitazone and metformin,
• For patients whose diabetes is not adequately controlled with metformin alone, or
• For patients who have initially responded to pioglitazone alone and require additional glycemic control.

Pioglitazone/metformin should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. There are no adequate and well-controlled studies in pregnant women with combination of pioglitazone and metformin or its individual components. It is not known whether pioglitazone and/or metformin are secreted inhuman milk. Because many drugs are excreted in human milk, pioglitazone/metformin should not be administered to a breastfeeding woman.^{[medical citation needed]}

Pioglitazone/metformin should not be used in people withtype 1 diabetes or for the treatment of diabetic ketoacidosis and should be used with caution in people with edema. Serum ALT levels should be evaluated prior to the initiation of therapy with combination of pioglitazone and metformin and periodically thereafter per the clinical judgment of the health care professional.^{[medical citation needed]}

The most common side-effects are upper respiratory tract infection, diarrhea, combined edema/peripheral edema and headache, respectively. Most clinical adverse events were similar between groups treated with pioglitazone in combination with metformin and those treated with pioglitazone monotherapy.^{[medical citation needed]}

Pioglitazone/metformin is contraindicated in people with known hypersensitivity to any components of this combination. These combination also contraindicated in renal disease which may also result from conditions, e.g., acutemyocardial infarction,sepsis, acute or chronicmetabolic acidosis, includingdiabetic ketoacidosis, with or without coma.^{[medical citation needed]}

Pioglitazone/metformin may interact with furosemide, nifedipine, cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, and vancomycin) and certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control (e.g., thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid).^{[medical citation needed]}

• Combination diabetes drugs
• Drugs developed by Takeda Pharmaceutical Company

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