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P-glitz M

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Indications:

Type 2 diabetes

Contraindications:

Hypersensitivity; diabetic coma, diabetic ketoacidosis; severe renal or hepatic impairment; recent MI, CHF; type 1 DM; severe infection; acute or chronic metabolic acidosis with or without coma; stress, trauma; severe impairment of thyroid function; dehydration, acute or chronic alcoholism; children <18 yr, pregnancy, lactation.

Adverse reactions:

Pioglitazone: Pharyngitis, oedema, headache, upper resp tract infection, sinusitis, anaemia; GI disturbances, wt gain, visual disturbances, dizziness, arthralgia, haematuria, impotence. Metformin: Anorexia, nausea, vomiting, diarrhoea, wt loss, flatulence, occasional metallic taste; weakness; hypoglycaemia; rash, malabsorption of vit B12. Potentially Fatal: Lactic acidosis in presence of renal failure and alcoholism.

Interactions:

Pioglitazone: Ketoconazole inhibits the metabolism of pioglitazone (in vitro). Increased hypoglycaemic effect with alcohol. Metformin: Additive effect with sulphonylureas. Antagonistic effects with diuretics, corticosteroids, phenothiazines, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, Ca channel blockers and isoniazid. Potentially Fatal: Pioglitazone: admin of a thiazolidinedione with OC reduces the plasma concentrations of the hormones which may result in the loss of contraceptive effectivity. Metformin: Lactic acidosis with alcohol and potentiation of hypoglycaemic effect. Cimetidine and furosemide may increase plasma-metformin levels. Drugs eliminated via renal tubular secretion may increase metformin levels.

Warnings:

Elderly. Monitor renal function regularly. Patients receiving pioglitazone in combination with insulin or oral hypoglycaemic agents may be at risk of hypoglycaemia. Oedema, congestive heart failure; hepatic dysfunction; jaundice. Premenopausal, anovulatory women, anaemia. Monitor liver function.

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