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What is pioglitazone? Pioglitazone is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. Pioglitazone is not for treating type 1 diabetes. Pioglitazone may also be used for purposes not listed in this medication guide. Warnings Pioglitazone can cause or worsen congestive heart failure. You should not use pioglitazone if you have severe or uncontrolled heart failure. Stop using this medicine and call your doctor at once if you have shortness of breath (especially when lying down), unusual tiredness, swelling, or rapid weight gain. Before taking this medicine You should not use this medicine if you are allergic to pioglitazone, or if you have: severe or uncontrolled heart failure; or diabetic ketoacidosis (call your doctor for treatment). This medication may increase your risk of developing bladder cancer. Talk with your doctor about your specific risk. Tell your doctor if you have ever had: congestive heart failure or heart disease; a heart attack or stroke; eye problems caused by diabetes; bladder cancer; or liver disease. Pioglitazone may increase your risk of serious heart problems, but not treating your diabetes can also damage your heart and other organs. Talk to your doctor about the risks and benefits of this medicine. Follow your doctor's instructions about using this medicine if you are pregnant or you become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications in both the mother and the baby. Pioglitazone may stimulate ovulation in a premenopausal woman and may increase the risk of unintended pregnancy. Talk to your doctor about your risk. Women may be more likely to have a broken bone while using pioglitazone. Talk with your doctor about ways to keep your bones healthy. It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. Pioglitazone is not approved for use by anyone younger than 18 years old. How should I take pioglitazone? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Pioglitazone is usually taken once daily, with or without food. You may have low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar (fruit juice, hard candy, crackers, raisins, or non-diet soda). Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency. Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule. Pioglitazone is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely. Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. You may have signs of low blood sugar, such as extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions). What should I avoid while taking pioglitazone? Avoid drinking alcohol. It lowers blood sugar and may interfere with your diabetes treatment. Pioglitazone side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using pioglitazone and call your doctor at once if you have symptoms of liver damage: nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes). Call your doctor at once if you have: shortness of breath (especially when lying down), unusual tiredness, swelling, rapid weight gain; pink or red urine, painful or difficult urination, new or worsening urge to urinate; changes in your vision; or sudden unusual pain in your hand, arm, or foot. Some people taking pioglitazone have had bladder cancer, but it is not clear if pioglitazone was the actual cause. Common side effects may include: headache; muscle pain; or cold symptoms such as stuffy nose, sinus pain, sneezing, sore throat. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Pioglitazone dosing information Usual Adult Dose for Diabetes Type 2: -Patients without congestive heart failure: Initial dose: 15 mg or 30 mg orally once a day -Patients with congestive heart failure (New York Heart Association [NYHA] Class I or II): Initial dose: 15 mg orally once a day Maintenance dose: 15 mg to 45 mg orally once a day based on glycemic response as determined by HbA1c Maximum dose: 45 mg orally once a day Comments: -This drug exerts its antihyperglycemic effect only in the presence of endogenous insulin and therefore is not expected to be effective in patients with type 1 diabetes mellitus or diabetic ketoacidosis. -Patients concomitantly receiving an insulin secretagogue or insulin may need to reduce the dose of the insulin secretagogue or insulin if hypoglycemia occurs. Use: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus in multiple clinical settings What other drugs will affect pioglitazone? Tell your doctor if you use insulin. Taking pioglitazone while you are using insulin may increase your risk of serious heart problems. Many drugs can affect pioglitazone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any medicine you start or stop using.
What is repaglinide? Repaglinide is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus. repaglinide is not for treating type 1 diabetes. Repaglinide may also be used for purposes not listed in this medication guide. Warnings You should not use repaglinide if you have type 1 diabetes, severe liver disease, or diabetic ketoacidosis. You should not use repaglinide together with gemfibrozil or NPH insulin (such as isophane insulin). Before taking this medicine You should not use repaglinide if you are allergic to it, or if you have: severe liver disease; or diabetic ketoacidosis (call your doctor for treatment). Many drugs can interact with repaglinide and some drugs should not be used at the same time. Your doctor may change your treatment plan if you also use: clopidogrel; cyclosporine; gemfibrozil; or NPH insulin (such as isophane insulin). Tell your doctor if you have ever had: liver disease; or if you also take metformin or other diabetes medicines. Follow your doctor's instructions about using repaglinide if you are pregnant or you become pregnant. Controlling diabetes is very important during pregnancy, and having high blood sugar may cause complications in both the mother and the baby. You should not breastfeed while using repaglinide. Repaglinide is not approved for use by anyone younger than 18 years old. How should I take repaglinide? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Repaglinide is usually taken 2 to 4 times daily, within 30 minutes before eating a meal. Follow your doctor's instructions. If you skip a meal, do not take your dose of repaglinide. Wait until your next meal. Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office. You may have low blood sugar (hypoglycemia) and feel very hungry, dizzy, irritable, confused, anxious, or shaky. To quickly treat hypoglycemia, eat or drink a fast-acting source of sugar (fruit juice, hard candy, crackers, raisins, or non-diet soda). Your doctor may prescribe a glucagon injection kit in case you have severe hypoglycemia. Be sure your family or close friends know how to give you this injection in an emergency. Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination. Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your dose or medication schedule. Repaglinide is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely. Store repaglinide at room temperature away from moisture and heat. What happens if I miss a dose? Take your dose as soon as you can, but only if you are getting ready to eat a meal. If you skip a meal, skip the missed dose and wait until your next meal. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. A repaglinide overdose can cause life-threatening hypoglycemia. Symptoms of severe hypoglycemia include extreme weakness, blurred vision, sweating, trouble speaking, tremors, stomach pain, confusion, and seizure (convulsions). What should I avoid while taking repaglinide? Avoid drinking alcohol. It lowers blood sugar and may interfere with your diabetes treatment. Repaglinide side effects Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling). Call your doctor at once if you have: pale or yellowed skin, dark colored urine, fever, confusion or weakness; or pancreatitis--severe pain in your upper stomach spreading to your back, nausea and vomiting. Common side effects may include: low blood sugar; nausea, diarrhea; headache, back pain; joint pain; or cold symptoms such as stuffy nose, sneezing, sore throat. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Repaglinide dosing information Usual Adult Dose for Diabetes Type 2: Individualize therapy: Dose preprandially 2, 3, or 4 times a day -For patients not previously treated with antidiabetic agents or whose glycosylated hemoglobin (HbA1c) is less than 8%: Initial dose: 0.5 mg orally with each meal -For patients previously treated with antidiabetic agents or whose HbA1c is 8% or higher: Initial dose: 1 or 2 mg orally with each meal Dose Adjustments: Based upon blood glucose response, double the preprandial dose up to a maximum meal time dose of 4 mg until satisfactory glycemic response is achieved; allow at least 1 week to assess response after each dose adjustment. Recommended Dose Range: 0.5 to 4 mg orally with each meal Maximum Daily Dose: 16 mg per day Comments: -Fasting blood glucose concentrations are generally used to adjust doses, however, postprandial glucose levels may be used in patients whose pre-meal blood glucose levels are satisfactory but whose overall glycemic control (HbA1c) is inadequate. -When hypoglycemia occurs in patients taking this drug in combination with a thiazolidinedione or metformin, the dose of this drug should be reduced. Use: As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. What other drugs will affect repaglinide? Many other medicines that can increase or decrease the effects of repaglinide on lowering your blood sugar. Some drugs can also cause you to have fewer symptoms of hypoglycemia, making it harder to tell when your blood sugar is low. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.