When your doctor tells you that you have Type 2 Diabetes Mellitus, you may be prescribed a pill that combines two medications, Pioglitazone and Metformin. It's normal to feel a little nervous and have a lot of questions when taking this medication. You may be wondering, "What exactly will this do?", "What should I be concerned about?", "Are the side effects dangerous?" Don't worry. Today, we'll simply answer all your questions about this medication.
What really happens with this medicine?
Simply put, this is a medicine that helps control your blood sugar, or glucose, levels. It is a combination of two medications.
1. Pioglitazone: This works by helping your body's insulin hormone work better. That is, it helps your body's cells absorb sugar from the blood more easily.
2. Metformin: This mainly controls blood sugar in two ways. One is by reducing the production of new sugar by your liver, and the other is by controlling the absorption of sugar from the food you eat.
This medicine is usually given in conjunction with a good diet and exercise . The medicine alone is not enough, but it is best taken in conjunction with lifestyle changes. In Sri Lanka, this medicine can be found under brand names such as `Actoplus Met XR`.
Things you need to tell your doctor before taking this medicine
It is very important that your doctor knows your complete medical history before prescribing this medication. Be sure to tell your doctor if you have any of the conditions listed below.
| Condition or habit | Why should you inform the doctor? |
|---|---|
| Heart disease or heart failure | Pioglitazone can increase fluid retention in the body, posing a risk to people with weak heart function. |
| Kidney or liver disease | Since these medications are eliminated from the body through the kidneys and liver, if their effectiveness is poor, the dosage may need to be adjusted. |
| Frequent drinking | Combining alcohol and Metformin increases the risk of a dangerous condition called lactic acidosis. |
| Being pregnant or trying to get pregnant, breastfeeding | This medicine is not suitable during pregnancy. It can also stimulate ovulation, so talk to your doctor about birth control if you are not planning to have children. |
| Vision problems, history of bladder cancer, anemia, polycystic ovary syndrome | It is essential to inform the doctor about these conditions as they may affect the effectiveness or side effects of the medication. |
| Allergies to other medicines, foods or substances | This is important to know if you are allergic to this medicine or any of its ingredients. |
How should I use the medicine?
As the doctor says, it is very important to take the right dose at the right time.
- Take with food: This medicine should always be taken with a meal. It is usually advised to take it with the main meal of the day.
- Swallow the tablet whole: Swallow the tablet whole with a glass of water. Never break, crush, or chew the tablet like a gum. This is an Extended Release (XR) tablet. This means that it is designed to release the medicine slowly throughout the day. If you break it, that process is disrupted, and the medicine can be released into the body all at once, causing side effects.
- Take it on time: Get into the habit of taking your medicine at the same time every day.
- If you miss a dose: If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose at the scheduled time. Never take two doses at the same time.
- If you overdose: If you think you have taken too much medicine, immediately call the National Poisons Information Centre at the Colombo National Hospital , or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
Sometimes the tablet coating may not dissolve and pass out with your stool. This is normal, so don't worry. The medicinal part of the medicine has been absorbed into your body.
Other things I should be aware of when taking the medicine
Regular medical checkups
Your doctor will check you regularly. In particular, they will do a blood test called HbA1c every 2-3 months to check how well your blood sugar is being controlled. They may also do tests to check your liver and kidney function.
Be aware of your blood sugar levels.
Learn how to test your blood sugar levels at home. Also, be aware of the symptoms of low blood sugar (Hypoglycemia) and high blood sugar (Hyperglycemia).
- Symptoms of low blood sugar: sweating, trembling, extreme hunger, confusion, and fainting.
- Symptoms of high blood sugar: excessive thirst, frequent urination, blurred vision, fatigue.
Always keep something nearby that you can eat quickly (glucose tablets, sugar cubes, toffee) in case your blood sugar drops.
Surgeries and scans
If you are going to have any surgery, MRI or CT scan, tell the medical team in advance that you are taking this medicine. You may need to stop taking the medicine a few days before the test.
Other medications
This medicine can interact with many other medicines, especially some contrast fluids used before scans, some heart medicines, hormonal pills (including birth control pills), some antibiotics and painkillers.
It is extremely important for your safety to tell your doctor about every medication, vitamin, and herbal remedy you take. Give him or her a complete list.
What side effects might I experience?
Like any medicine, this can have side effects. However, not everyone gets them. You can learn more about this from the table below.
| If you experience these symptoms, tell your doctor immediately or go to a hospital. | |
|---|---|
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Symptoms of heart failure | Difficulty breathing, swelling of the ankles, feet or hands, sudden weight gain, extreme fatigue. |
| Lactic Acidosis | This is a rare but very dangerous condition. Muscle twitching or pain, stomach pain, difficulty breathing, extreme fatigue. |
| Symptoms of liver injury | Pain in the upper right side of the stomach, loss of appetite, nausea, yellowing of the skin or eyes, dark yellow/brown urine. |
| Other serious symptoms | Vision changes (blurring, seeing rings around lights), urine that is red or dark brown, pain when urinating. |
| If these symptoms persist or are bothersome, tell your doctor. | |
| Common side effects | Diarrhea, headache, nausea, runny or stuffy nose. |
Take-Home Message
- Do not stop using this medicine without asking your doctor.
- Always take the medicine with a meal. Swallow the tablet whole, do not break it.
- Give your doctor a complete list of all other medications, vitamins, and herbs you are taking.
- Be aware of the symptoms of low blood sugar (hypoglycemia) and keep something with sugar nearby in case of an emergency.
- Seek immediate medical attention if you experience any serious side effects such as chest pain, difficulty breathing, or severe stomach pain.
- It is very important for your health to see your doctor on time and undergo the necessary tests.
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