Pioglitazone Metformin

Starting dose for patients inadequately controlled on metformin monotherapy -Based on the usual starting dose of pioglitazone (15 to 30 mg daily), pioglitazone/metformin may be initiated at either the 15 mg/500 mg or 15 mg/850 mg tablet strength once or twice daily, and gradually titrated after assessing adequacy of therapeutic response. 

Children Pioglitazone/metformin is not recommended for use in pediatric patients. 

Elderly The initial and maintenance dosing of pioglitazone/metformin should be conservative in patients with advanced age, due to the potential for decreased renal function in this population. Any dosage adjustment should be based on a careful assessment of renal function. Generally, elderly, debilitated, and malnourished patients should not be titrated to the maximum dose of pioglitazone/metformin. Monitoring of renal function is necessary to aid in prevention of metformin-associated lactic acidosis, particularly in the elderly. 

Liver function impairment Therapy with pioglitazone/metformin should not be initiated if the patient exhibits clinical evidence of active liver disease or increased serum transaminase levels (ALT greater than 2.5 times the ULN) at start of therapy. Liver enzyme monitoring is recommended in all patients prior to initiation of therapy with pioglitazone/metformin and periodically thereafter. 

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