Thiazolidinedione + biguanide
Pioglitazone with metformin
Brand names: Competact
Adult dose
Dose: 15/850mg PO BD
Route: PO
Frequency: BD
Dose adjustments
Renal
Avoid metformin if eGFR <30; reduce if 30–45
Clinical pearls
- T2DM when monotherapy inadequate
- Avoid in HF — pioglitazone causes fluid retention
Contraindications
- Heart failure (any class)
- Active or history of bladder cancer
- Uninvestigated macroscopic haematuria
- Severe renal impairment
- Severe hepatic impairment
- Diabetic ketoacidosis
Side effects
- Weight gain
- Oedema
- HF exacerbation
- Bladder cancer (small risk)
- Bone fractures
- GI upset (metformin)
- B12 deficiency
- Lactic acidosis (rare)
Interactions
- Insulin (hypoglycaemia)
- Iodinated contrast (suspend metformin)
- Alcohol
- Gemfibrozil
Monitoring
- HbA1c
- LFTs
- Weight
- B12
- Renal function
Reference: BNF; NICE NG28; https://bnf.nice.org.uk/drugs/pioglitazone-with-metformin/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Diabetic Ketoacidosis (DKA) · JBDS 2013 / Joint British Diabetes Societies; NICE NG17
- Adult Hypoglycaemia (Treated Diabetes) · JBDS-IP (2023): Hospital Management of Hypoglycaemia
- Adrenal Crisis · Society for Endocrinology Emergency Guidance (2024)
- Type 2 Diabetes Management · NICE NG28 2022
- Hyperthyroidism Management · BTA / ETA 2018
- Adrenal Insufficiency · Society of Endocrinology / ESE 2016