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Diabetic. Taking pioglit15. Suggested to take Amaryl now. What to do?

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I have been taking pioglit15 twice daily once after breakfast and the other after dinner. the sugar control fairly OK as H1Abc is 7.2 for few years. Now the doctor says that I must stop pioglit with immediate effect. He says it has lot of side effects and it is banned in few countries. Alongwit pioglit I take Amaryl 2mg in the morning after breakfast. What do I do ? Please advise.
Posted Thu, 18 Jul 2013 in Diabetes
Answered by Dr. Shehzad Topiwala 1 hour later
Yes I concur with your doctor's thoughts on pioglit(azone).

Amaryl 2 mg is fine but monitor your sugars carefully and frequently enough to ensure you do not suffer low sugar reactions ie hypoglycemia.

Also, check with your diabetes specialist if you are a candidate for metformin. It is an oral medication for type 2 diabetes. If you do not have any major heart / lung /liver /kidney problem or past intolerance to it, then you should strongly consider it.

If you do start it then it is possible you may need a different dose of Amaryl. This is hard to predict as individual responses vary. So you may need less or more of Amaryl after metformin is started. Or you may even settle on the same dose as now.

If metformin is not an option, then doe adjustments of Amaryl done cautiously will likely allow you to control your diabetes well.
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Follow-up: Diabetic. Taking pioglit15. Suggested to take Amaryl now. What to do? 17 hours later
Doctor has now suggested as follows : Diapride 2mg before breakfast; X.met SR 1 GM afterbreakfast & X.met SR 500 mg after dinner He has asked me to discontinue Amaryl 2mg.
Is this OK.?
Thanks for your response and advice.
Answered by Dr. Shehzad Topiwala 6 hours later
In general it looks like a rationale plan. I personally start metformin low and slow ie I start with 500 mg XR with dinner every other day for one week then if there are no side effects (like stomach upset, diarrhea, nausea etc) I recommend proceeding to 500 mg with breakfast and 500 mg with dinner. Then if there are no further side effects I advise taking 2 pills with dinner and 1 with breakfast for the next week. Thereafter I recommend 2 with breakfast and 2 with dinner. If there are no tolerability issues, then I change the 500 mg tablet to 1000 mg tablet and ensure a total of 2000 mg of metformin are taken daily in the simplest way ie with the least number of pills
It is important to know that as greater amounts of metformin are taken, the dose of diapride may need to be reduced to avoid the risk of low sugar reactions
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