ActoPlus Met (pioglitazone, metformin) is a combination tablet that helps patients with type 2 diabetes manage blood sugar levels. This product is not effective for those with type 1 diabetes or who are in diabetic ketoacidosis.

Lifestyle changes are typically recommended along with taking ActoPlus Met, including dietary changes, regular exercise, quitting smoking, and so forth. Some patients are eventually able to stop relying on medications to manage blood sugar levels if such changes are made and maintained over the long term.

Use of ActoPlus in pregnancy is somewhat controversial, though in general it is considered safer than allowing diabetes to go unchecked. Effects on unborn human babies are not well studied. In animal studies even very high doses did not produce problems.

Treatment Overview

Patients prescribed ActoPlus Met typically do not take insulin injections and are committed to making lifestyle changes. It can be taken with insulin, but dosage modification will be needed. Likewise it will provide benefit it lifestyle changes are not made, but they won't be as significant.

ActoPlus Met comes in tablets, typically taken once or twice per day, and at very high doses three times per day. Tablets are available in strengths ranging from 15 mg pioglitazone/500 mg metformin to 45 mg pioglitazone/2550 mg metformin.

Patients should not exceed 45 mg pioglitazone or 2550 mg metformin in one day. Doses of metformin over 2000 mg are typically taken three times per day, and sometimes lower doses as well if metformin causes gastrointestinal upset.

In otherwise healthy patients:

• Start with 15/500 mg pioglitazone/metformin twice per day.
• Dosage may be gradually titrated higher if needed, assuming the medication is well tolerated.
• Do not exceed 45 mg pioglitazone or 2550 mg metformin in one day

Treatment is ideally individualized; a doctor can take into consideration the many different factors that may influence dosage. Patients with other major medical issues---such as congestive heart failure or liver impairment---will likely need lower doses, or may not be good candidates for ActoPlus Met at all.

Patients should monitor blood sugar closely at the start of treatment or following any dosage adjustments to ActoPlus Met or any other antidiabetic medication.

ActoPlus Met is typically prescribed when:

• A patient is taking only pioglitazone and needs another antidiabetic medication;
• A patient is taking only metformin and needs another antidiabetic medication;
• A patient is taking both metformin and pioglitazone separately and wishes to combine them to one tablet;
• Rarely when a patient is taking nothing and a doctor believes multiple medications are needed.

The prescribing doctor should be made aware of all other medications being taken before starting ActoPlus Met, not just other antidiabetic medications. ActoPlus Met can interact with many other medications, potentially causing serious complications.

Warnings Before Use

Unfortunately not everyone is a good candidate for ActoPlus Met. Patients who should not take it include those who:

• Have a history of allergy to thiazolidinediones or metformin
• Have severe heart failure
• Have or are at high risk of bladder cancer
• Have severe kidney disease

Those who may be able to take ActoPlus Met but may require modified dosing or increased monitoring for side effects include those with a history of:

• Fluid retention
• Bladder cancer
• Diabetes-related eye disorders
• Liver impairment
• Mild to moderate kidney issues
• Mild to moderate congestive heart failure
• Heart attack
• Stroke

This medication can complicate congestive heart failure in some patients. Untreated diabetes can also do so. Individuals with preexisting heart problems should discuss risks with a doctor; ActoPlus Met may be recommended, but so may another medication. Again treatment should be individualized.

Potential Side Effects

Most side effects from ActoPlus Met in otherwise healthy patients are mild and not cause for concern unless severe persistant past the first few weeks of treatment, including:

• Headache
• Tooth sensitivity
• Mild muscle pain
• Sinus pain or pressure
• Sore throat
• Sneezing
• Mild weight gain
• Diarrhea

More rare, but more serious, side effects can also develop. Seek immediate medical attention if experiencing:

• Vision changes
• Pain in hands, feet, or arms
• Feeling cold
• Slow or irregular heartbeat
• Difficulty breathing
• Difficulty urinating
• Pink, red, or dark urine
• Severe stomach pain
• Jaundice
• Fatigue
• Edema

The above conditions can usually be addressed and resolved, especially if caught early. Attending regular doctor checkups will help screen for developing complications. Only a very small percentage of patients taking ActoPlus Met will develop any of the above side effects.