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Pioglitazone may rarely cause or worsen a certain heart problem (heart failure). Tell your doctor right away if you notice any symptoms of heart failure.including. shortness of breath.swelling ankles/feet.unusual tiredness.unusual/sudden weight gain.

If hypoglycemia occurs in a patient coadministered ACTOPLUS MET and an insulin secretagogue (e.g..sulfonylurea).the dose of the insulin secretagogue should be reduced.

Some people develop lactic acidosis while taking metformin. Early symptoms may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms such as. muscle pain or weakness.numb or cold feeling in your arms and legs.trouble breathing.stomach pain.nausea with vomiting.fast or uneven heart rate.dizziness.or feeling very weak or tired.

Lactation. not known if crosses into breast milk.avoid using in nursing women.

ACTOPLUS MET should be used with caution in patients with edema. Because thiazolidinediones.including pioglitazone.can cause fluid retention.which can exacerbate or lead to congestive heart failure.ACTOPLUS MET should be used with caution in patients at risk for congestive heart failure. Patients treated with ACTOPLUS MET should be monitored for signs and symptoms of congestive heart failure [see BOXED WARNING .Congestive Heart Failure .and PATIENT INFORMATION ].

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