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Pioglitazone/metformin helps lower blood sugar levels in people with type 2 diabetes. Pioglitazone/metformin helps insulin work better, reduces the amount of sugar your liver makes, and reduces how much sugar your body absorbs from the things you eat and drink. Common side effects are fluid retention, headache, and diarrhea. Notify your healthcare provider if you have severe or frequent episodes of low blood sugar.

Uses

What is pioglitazone/metformin used for?

Pioglitazone/metformin is commonly used to help lower blood sugar levels in people with type 2 diabetes.

Pioglitazone/metformin may also be used for other conditions as determined by your healthcare provider.

How does pioglitazone/metformin work (mechanism of action)?

Pioglitazone/metformin works in several ways to help keep your blood glucose (sugar) from getting too high. It increases insulin sensitivity (how your body responds to your own insulin). This helps your body use sugar for energy. It decreases the amount of sugar your body absorbs from things you eat and drink and decreases the amount of sugar your liver makes.

How is pioglitazone/metformin supplied (dosage forms)?

Brand and other names

  • Actoplus Met

Dosage forms and strengths

  • 15 mg/500 mg oral tablets
  • 15 mg/850 mg oral tablets

How should I store pioglitazone/metformin?

Pioglitazone/metformin should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of pioglitazone/metformin?

The most common side effects of pioglitazone/metformin are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Infection in the nose or throat, sore throat, or common cold symptoms
  • Edema (fluid retention) (see below)
  • Diarrhea
  • Headache
  • Weight gain

There may be other side effects of pioglitazone/metformin that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of pioglitazone/metformin?

While less common, the most serious side effects of pioglitazone/metformin are described below, along with what to do if they happen.

Severe Allergic Reactions. Pioglitazone/metformin may cause allergic reactions, which can be serious. Stop taking pioglitazone/metformin and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Heart Failure. Pioglitazone/metformin may increase your risk of heart failure especially if you also use insulin. Tell your healthcare provider right away if you have any of the following symptoms of heart failure.

  • Shortness of breath or trouble breathing, especially while lying down
  • Swelling in your feet, ankles, or legs
  • Unusually fast weight gain
  • Unusual tiredness

Lactic Acidosis. Pioglitazone/metformin may cause lactic acidosis (a buildup of lactic acid in your blood), which can be serious. Stop taking pioglitazone/metformin and get help right away if you have any of the following symptoms of lactic acidosis.

  • General ill feeling
  • Muscle pain
  • Difficulty breathing
  • Drowsiness 
  • Stomach pain 

Vitamin B12 Deficiency. Pioglitazone/metformin may cause you to have low levels of vitamin B12 in your blood (possibly by decreasing the amount of vitamin B12 your body absorbs from things you eat or drink), which may lead to anemia (low levels of red blood cells). Your healthcare provider will likely use lab tests to check your vitamin B12 levels and for anemia. Tell your healthcare provider right away if you have any of the following symptoms of anemia.

  • Unusual weakness or tiredness
  • Cold hands and feet
  • Fast or abnormal heartbeat
  • Pale or yellowish skin
  • Dizziness, lightheadedness, or feeling like you are about to pass out
  • Shortness of breath

Low Blood Sugar (Hypoglycemia). When pioglitazone/metformin is used with insulin or other medicines that lower your blood sugar by increasing your body’s own insulin levels, it can cause hypoglycemia. The doses of the other medicines may need to be changed when taken with pioglitazone/metformin. Call your healthcare provider right away if you have any of the following symptoms of low blood sugar.

  • Headache
  • Crankiness or anxiety
  • Hunger
  • Dizziness or confusion
  • Blurry vision
  • Slurred speech
  • Sweating
  • Feeling jittery or shakiness
  • Fast heartbeat
  • Seizures

Edema (Fluid Retention). Pioglitazone/metformin may cause fluid to build up in your body, especially if you take a higher dose. Tell your healthcare provider right away if you notice swelling in your feet, ankles, or legs, or unexplained weight gain. 

Fractures (Broken Bones). Pioglitazone/metformin may increase your risk of breaking a bone (usually in the hand, arm, or feet), especially in females. Talk with your healthcare provider about how to keep your bones healthy.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking pioglitazone/metformin. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Bladder Cancer. You may be more likely to get bladder cancer if you take pioglitazone/metformin. Tell your healthcare provider right away if you have any of the following symptoms of bladder cancer.

  • Red pee or blood in your pee
  • Pain when you pee
  • Need to pee more often than normal

Macular Edema. Pioglitazone/metformin may increase your risk of macular edema (increased fluid in parts of your eye). You may not have any symptoms, so keep your scheduled eye appointments. Tell your healthcare provider right away if you notice changes in your vision. 

Warnings & Precautions

Who should not use pioglitazone/metformin?

Allergies to Ingredients. People who are allergic to any of the following should not take pioglitazone/metformin.

  • Actoplus Met
  • Pioglitazone
  • Metformin
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific pioglitazone/metformin products they stock.

Kidney Problems. Pioglitazone/metformin should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to take this medicine.

Heart Failure. People with New York Heart Association (NYHA) Class III or IV heart failure (moderate to severe heart failure) should not start taking pioglitazone/metformin. 

Metabolic Acidosis, Including Diabetic Ketoacidosis. Pioglitazone/metformin should not be used in people with acute or chronic metabolic acidosis (when the chemical balance of acids and bases in your blood gets thrown off). Tell your healthcare provider if you have a history of metabolic acidosis or diabetic ketoacidosis.

What should I know about pioglitazone/metformin before using it?

Do not take pioglitazone/metformin unless it has been prescribed to you by a healthcare provider. Take it as prescribed. 

Do not share pioglitazone/metformin with other people, even if they have the same condition as you. It may harm them.

Keep pioglitazone/metformin out of the reach of children.

Pioglitazone/metformin can cause ovulation (release of an egg from your ovary), if you have not gone through menopause, even if you do not have regular periods. This can increase your chance of getting pregnant.

Take pioglitazone/metformin with meals to reduce the risk of an upset stomach.

Certain conditions that cause increased stress on your body, like fever, trauma (such as a car accident), infection, or surgery can change the amount of diabetes medicines you need to take to control your diabetes. Talk to your healthcare provider if you have any of these conditions to decide if your medicine needs to be changed.

Talk to your healthcare provider about how to prevent, recognize, and manage low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and diabetes-related problems.

People who are 65 years or older can be at greater risk for some side effects from pioglitazone/metformin. Talk to your healthcare provider about your risks if you are in this age group.

What should I tell my healthcare provider before using pioglitazone/metformin?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if pioglitazone/metformin is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

  • Type 1 diabetes
  • Heart problems, including congestive heart failure or a heart attack
  • Macular degeneration
  • Liver problems
  • Bladder cancer
  • Drink alcohol often or in large amounts
  • Stroke
  • Dehydration
  • Severe infection
  • Have an upcoming medical test that uses contrast (a special dye), surgery, or other procedure

Other Medicines and Supplements. Pioglitazone/metformin may interact with other medicines and supplements. Before taking pioglitazone/metformin, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how pioglitazone/metformin could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. If you get pregnant, talk to your healthcare provider about how to control your blood sugar while you are pregnant. 

Breastfeeding. It is unknown if metformin/pioglitazone passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take pioglitazone/metformin while breastfeeding.

Interactions

Does pioglitazone/metformin interact with foods or drinks?

There are no known interactions between pioglitazone/metformin and foods or drinks.

Alcohol can increase the risk of lactic acidosis. See the Side Effects section for more details. It is unknown if drinking alcohol will affect pioglitazone/metformin, but alcohol may affect blood sugar levels in people with diabetes. This may interfere with the effect of pioglitazone/metformin. It is best to limit the amount of alcohol you drink.

Does pioglitazone/metformin interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking pioglitazone/metformin.

  • A carbonic anhydrase inhibitor, such as zonisamide (Zonegran), acetazolamide (Diamox), or methimazole
  • Topiramate (Topamax), which is a medicine commonly used to treat seizures or prevent migraine
  • A medicine for diabetes, especially insulin or any medicine that increases your insulin levels

Many other medicines can increase your blood sugar and can interfere with the effect of pioglitazone/metformin. Talk to your pharmacist or healthcare provider before starting or stopping other medicines while taking pioglitazone/metformin. You may need to monitor your blood sugar levels more closely during these times.

Some other medicines may alter the blood levels of pioglitazone/metformin. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with pioglitazone/metformin. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much pioglitazone/metformin?

If you or someone else has used too much pioglitazone/metformin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of pioglitazone/metformin?

If you miss a dose on one day, do not take double or extra doses for your next dose.

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