Glitamin

General

Antihyperglycemic treatment for type 2 diabetes should be chosen to suit the individual patient, based on how well it works and how well it is tolerated. The daily dose must not go above the maximum of Pioglitazone 45 mg and Metformin 2550 mg.

Dosage Recommendations

The starting dose of Pioglitazone & Metformin should depend on what the patient is already taking, Pioglitazone, Metformin, or both. The tablets should be given in divided daily doses with meals, which helps reduce the stomach and bowel side effects linked to Metformin.

Starting dose for patients inadequately controlled on Metformin monotherapy

The usual starting dose of Pioglitazone is 15 to 30 mg daily. On that basis, Pioglitazone & Metformin may be started at either the 15 mg/500 mg or the 15 mg/850 mg tablet strength, once or twice daily. The dose is then raised gradually after checking how well the patient has responded.

Starting dose for patients who initially responded to Pioglitazone monotherapy and require additional glycemic control

The usual starting doses of Metformin are 500 mg twice daily or 850 mg daily. On that basis, Pioglitazone & Metformin may be started at either the 15 mg/500 mg tablet twice daily or the 15 mg/850 mg tablet once daily. The dose is then raised gradually after checking how well the patient has responded.

Starting dose for patients switching from combination therapy of Pioglitazone plus Metformin as separate tablets

Pioglitazone & Metformin may be started with either the 15 mg/500 mg or the 15 mg/850 mg tablet strength, depending on the doses of Pioglitazone and Metformin the patient is already taking.

Maximum Recommended Dose

Pioglitazone & Metformin tablets come as 15 mg Pioglitazone plus 500 mg Metformin, or 15 mg Pioglitazone plus 850 mg Metformin, for oral use. The maximum recommended dose of Pioglitazone is 45 mg daily. The maximum recommended daily dose of Metformin in adults is 2550 mg.

Special Patient Populations

In patients of advanced age, both the starting dose and the maintenance dose of the Pioglitazone and Metformin combination should be conservative, because kidney function may be reduced in this group. Elderly, debilitated and malnourished patients generally should not be raised to the maximum dose. Kidney function needs to be monitored to help prevent Metformin-associated lactic acidosis, particularly in the elderly.

Don't start therapy with the combination if the patient shows clinical evidence of active liver disease, or if serum transaminase levels are raised (ALT greater than 2.5 times the upper limit of normal) at the start. Liver enzymes should be checked in all patients before starting the combination of Pioglitazone and Metformin, and then periodically afterwards.