— Product
GLYCYROSS-MP2 SR TAB
GLIMEPIRIDE 2MG + METFORMIN + PIOGLITAZONE 15MG
GLYCYROSS-MP2 SR TAB is a tablet combining glimepiride 2 mg, metformin and pioglitazone 15 mg, a triple oral combination for type 2 diabetes mellitus. It is used where dual therapy has failed to achieve adequate glycaemic control, adding a thiazolidinedione to improve insulin sensitivity further.
01
Benefits
- Three complementary mechanisms — reduced hepatic glucose output, stimulated insulin secretion, and improved peripheral insulin sensitivity.
- Pioglitazone acts on muscle and fat tissue to improve insulin sensitivity, addressing a mechanism the other two do not.
- Pioglitazone has a durable glucose-lowering effect that is maintained over years better than sulphonylureas alone.
- A single tablet replaces three, which matters substantially for adherence.
- Useful in markedly insulin-resistant patients where metformin and a sulphonylurea are insufficient.
02
Side effects
Not everyone gets these. Most are mild and settle as the course finishes.
Common
- Hypoglycaemia — sweating, tremor, hunger, palpitations, confusion
- Weight gain, from both the glimepiride and the pioglitazone
- Fluid retention and ankle swelling
- Nausea or diarrhoea
Less common
- Anaemia
- Headache or dizziness
- Vitamin B12 deficiency with long-term metformin use
- Visual disturbance from macular oedema
Stop and get medical help if any of these occur
- Breathlessness, rapid weight gain or marked swelling of the legs — this may be heart failure
- Severe hypoglycaemia with confusion, seizures or loss of consciousness
- Deep rapid breathing, severe weakness and vomiting — this may be lactic acidosis
- Blood in the urine, or pain or urgency on passing urine
- Bone pain or a fracture after minor injury
- Yellowing of the skin or eyes
03
Precautions
- Pioglitazone causes fluid retention and can precipitate or worsen heart failure. Contraindicated in heart failure of any grade, and stop immediately if breathlessness, oedema or rapid weight gain develops.
- Pioglitazone increases fracture risk, particularly in women, and has been associated with bladder cancer — contraindicated in active bladder cancer or unexplained haematuria.
- Glimepiride causes hypoglycaemia, which can be severe and prolonged. Patients must know the symptoms and carry fast-acting glucose, and never skip meals.
- Metformin can cause lactic acidosis — stop during acute illness with dehydration, before contrast procedures and before major surgery.
- Contraindicated in type 1 diabetes, diabetic ketoacidosis, significant renal impairment, hepatic impairment and active liver disease.
- Check liver function before starting pioglitazone and periodically thereafter.
- Swallow the sustained-release tablet whole, take with the first main meal, and avoid excess alcohol.
- Contraindicated in pregnancy and breastfeeding. This triple combination should be reviewed regularly rather than continued indefinitely without reassessment.