سعر افيروفاج 15/850 مجم 30 قرص 2024

Pioglitazone 15 mg + metformin 850 mg film-coated tablets, 30 tablets; oral antidiabetic combination (Averroes Pharma, Egypt).

• Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitusPopulation: AdultsDailyMed (U.S. National Library of Medicine)

• Most common adverse reactions (>5%): upper respiratory tract infection, diarrhea, combined edema/peripheral edema, headache and weight gain.International label, same formulation · DailyMed (U.S. National Library of Medicine)

• Established NYHA class III or IV heart failure at initiation; severe renal impairment (eGFR below 30 mL/min); serious hypersensitivity to pioglitazone, metformin or excipients; acute or chronic metabolic acidosis including diabetic ketoacidosis.International label, same formulation · DailyMed (U.S. National Library of Medicine)
• Not for type 1 diabetes or diabetic ketoacidosis (limitation of use).International label, same formulation · DailyMed (U.S. National Library of Medicine)

• Boxed warning - congestive heart failure: thiazolidinediones cause or worsen heart failure; monitor for rapid weight gain, dyspnea and edema; not recommended in symptomatic heart failure.International label, same formulation · DailyMed (U.S. National Library of Medicine)
• Boxed warning - lactic acidosis: postmarketing metformin-associated lactic acidosis, sometimes fatal; risk factors include renal impairment, age 65 or older, radiologic contrast, surgery, hypoxic states, excessive alcohol and hepatic impairment; discontinue immediately if suspected and start supportive care (hemodialysis recommended).International label, same formulation · DailyMed (U.S. National Library of Medicine)
• Edema (dose-related) and hypoglycemia when used with insulin or insulin secretagogues (a lower dose of these may be needed).International label, same formulation · DailyMed (U.S. National Library of Medicine)

• Strong CYP2C8 inhibitors (e.g. gemfibrozil)Increase pioglitazone exposure; limit the combination to one tablet (15 mg pioglitazone) daily.DailyMed (U.S. National Library of Medicine)
• CYP2C8 inducers (e.g. rifampin)May decrease pioglitazone exposure; if an inducer is started or stopped, adjust therapy based on response without exceeding the maximum dose.DailyMed (U.S. National Library of Medicine)
• Carbonic anhydrase inhibitors (e.g. topiramate, zonisamide, acetazolamide)May cause metabolic acidosis and increase the risk of lactic acidosis; monitor more frequently.DailyMed (U.S. National Library of Medicine)

• Limited data with pioglitazone/metformin or pioglitazone in pregnant women are insufficient to determine a drug-associated risk; published metformin studies have not shown a clear association with major birth defects or miscarriage. Poorly controlled diabetes carries maternal and fetal risks.International label, same formulation · DailyMed (U.S. National Library of Medicine)
• No information on pioglitazone in human milk (present in rat milk); limited published studies report metformin in human milk. Weigh the benefits of breastfeeding against the mother's need for the drug and possible infant effects.International label, same formulation · DailyMed (U.S. National Library of Medicine)

• Pioglitazone: Thiazolidinedione that depends on the presence of insulin; decreases insulin resistance in the periphery and liver via PPAR-gamma agonism (US Duetact label).
• Metformin: Decreases hepatic glucose production, decreases intestinal glucose absorption and improves insulin sensitivity by increasing peripheral glucose uptake and utilization; insulin secretion remains unchanged (US label).