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Generic Name:

metformin-rosiglitazone, Oral tablet

All Brands

  • Avandamet
SECTION 1 of 4

Highlights for metformin-rosiglitazone

Oral tablet
1

Metformin/rosiglitazone is a combination of two drugs in a single form that’s used to treat high blood sugar levels caused by type 2 diabetes. It’s used along with diet and exercise.

2

This drug is given in divided doses with meals, usually twice a day. It’s important to take it at the same time each day to avoid big changes in your blood sugar levels.

3

Before you start metformin/rosiglitazone, you should tell your doctor if you have severe heart failure, kidney problems, type 1 diabetes, diabetic ketoacidosis, or the eye disease macular edema, or if you drink a lot of alcohol. You may not be able to take this drug combination or you may need a lower dose.

4

Common side effects include diarrhea, nausea, upset stomach, cold-like symptoms (such as nasal congestion or a sore throat), headache, joint aches, and dizziness.

5

Lactic acidosis is a rare side effect of this drug that can be fatal. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital.

IMPORTANT INFORMATION

FDA warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Heart failure warning: Rosiglitazone can cause or worsen heart failure. Symptoms of heart failure include:

  • fast weight gain
  • shortness of breath or trouble breathing, especially when you lay down
  • swelling or fluid retention in your ankles or legs
  • unusual tiredness

Call your doctor right away if you have any signs of heart failure. Your doctor should monitor you carefully when starting this medication and when changing doses.

If you have signs of heart failure, you shouldn’t take this medication. You cannot take rosiglitazone if you have New York Heart Association (NYHA) Class III or IV heart failure. 

Lactic acidosis warning: Lactic acidosis is a rare, but serious side effect of metformin. In this condition, lactic acid builds up in your blood. This is a medical emergency that requires treatment in the hospital. Lactic acidosis is fatal in about half of people who develop it. You should stop taking metformin and call your doctor right away or go to the emergency room if you have signs of lactic acidosis. Symptoms include:

  • tiredness
  • weakness
  • unusual muscle pain
  • trouble breathing
  • unusual sleepiness
  • stomach pains, nausea, or vomiting
  • dizziness or lightheadedness
  • slow or irregular heart rate

Your risk of developing lactic acidosis may be higher if you have:

  • sepsis, a serious complication of an infection
  • dehydration
  • liver problems
  • kidney problems
  • heart failure
  • alcohol use disorder

Not for type 1 diabetes

You shouldn’t use this drug if you have type 1 diabetes or diabetic ketoacidosis (a complication that occurs when your body produces high levels of ketones). These conditions should be treated with insulin instead.

Risk of becoming pregnant

Rosiglitazone may cause you to ovulate (release of an egg from your ovary), which can lead to pregnancy. Ovulation may occur even if you don’t have regular menstrual periods. Ask your doctor about effective forms of birth control while you’re taking this medication.

X-ray procedure warning

You’ll need to stop taking metformin for a short time if you plan to have an injection of dye or contrast for an x-ray procedure. This can affect how your kidneys work and put you at risk for lactic acidosis.

What is metformin/rosiglitazone?

This drug is a prescription drug. It’s available as an oral tablet.

This drug is available as a generic drug. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

This is a combination of two or more drugs in a single form. It is important to know about all the drugs in the combination because they each may have unique traits.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

Why it's used

This drug is a combination of two drugs in a single form that’s used to treat high blood sugar levels caused by type 2 diabetes. It’s used along with diet and exercise.

How it works

This drug is a combination of two medications that work in different ways.

More Details

How it works

This drug is a combination of two medications that work in different ways.

Metformin belongs to a class of drugs called biguanides. A class of drugs refers to medications that work similarly. They are often used to treat similar conditions.

This drug works by decreasing the amount of sugar (glucose) made by your liver and the amount of glucose absorbed after you eat. Metformin also increases your body’s response to insulin. Insulin is a chemical your body makes that helps to move sugar out of your bloodstream and into your body’s cells, where it belongs. Once the sugar enters your cells, they’re able to use the sugar as fuel for your body. If your body doesn’t make enough insulin on its own or if it can’t use insulin properly, the sugar will stay in your bloodstream. This causes high blood sugar (hyperglycemia).

Rosiglitazone belongs to a class of drugs called thiazolidinediones. This drug improves how your body responds to the insulin that your body makes.   

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SECTION 2 of 4

metformin-rosiglitazone Side Effects

Oral tablet

Most Common Side Effects

The most common side effects that occur with metformin/rosiglitazone include:

  • diarrhea, nausea, and upset stomach:

    • Taking this drug with food can help reduce these side effects.
    • These issues usually go away after a few weeks. Stomach problems that start up later during treatment may be serious and should be discussed with your doctor.
  • cold-like symptoms, such as nasal congestion and sore throat

  • headache

  • joint aches

  • dizziness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life-threatening or if you think you’re experiencing a medical emergency, call 9-1-1.

  • severe low blood sugar (hypoglycemia). Symptoms include:

    • mood changes, such as irritability, impatience, anger, stubbornness, or sadness
    • confusion, including delirium
    • lightheadedness or dizziness
    • sleepiness
    • blurred or impaired vision
    • tingling or numbness in your lips or tongue
    • headaches
    • weakness or fatigue
    • lack of coordination
    • nightmares or crying out during your sleep
    • seizures
    • loss of consciousness
  • heart failure. Symptoms include:  

    • swelling or fluid retention, especially in your ankles or legs
    • shortness of breath or trouble breathing, especially when you lie down
    • an unusually fast increase in weight
    • unusual tiredness
  • heart attack. Symptoms include:

    • chest pain in the center of your chest that lasts for more than a few minutes, or that goes away or comes back
    • uncomfortable pressure, squeezing, fullness, or pain in your chest
    • pain or discomfort in your arms, back, neck, jaw, or stomach
    • shortness of breath with or without chest pain
    • breaking out in a cold sweat
    • nausea or vomiting
  • swelling (edema). Rosiglitazone can cause your body to retain fluid, which leads to swelling and weight gain.

  • liver problems. Symptoms include: 

    • nausea
    • vomiting
    • stomach pain
    • unusual or unexplained tiredness
    • loss of appetite
    • dark-colored urine
    • yellowing of your skin or the whites of your eyes
  • broken bones (fractures). These usually occur in the hand, upper arm, or foot. Women are at a higher risk. Ask your doctor how to keep your bones healthy.

  •  diabetic eye disease (macular edema). Symptoms include:

    • changes in your vision
  • low red blood cell count (anemia). Symptoms include:

    • fast heart rate
    • chest pain
    • trouble breathing when exerting yourself
    • lightheadedness or dizziness
    • tiredness
    • weakness
    • confusion
    • pale-looking skin
  • ovulation. This can increase your chance of getting pregnant. Use effective birth control while you’re taking this drug.

Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug does not cause drowsiness. However, it may cause a low blood sugar reaction.

If you have a low blood sugar reaction, you need to treat it.

  • For mild hypoglycemia (55–70 mg/dL), treatment is 15–20 grams of glucose (a type of sugar). You need to eat or drink one of the following:
    • 3–4 glucose tablets
    • a tube of glucose gel
    • ½ cup of juice or regular, non-diet soda
    • 1 cup of nonfat or 1% cow’s milk
    • 1 tablespoon of sugar, honey, or corn syrup
    • 8–10 pieces of hard candy, such as lifesavers
  • Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, then repeat the above treatment again.
  • Once your blood sugar is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later. 

If you don’t treat low blood sugar, you can have a seizure, pass out, and possibly develop brain damage. Low blood sugar can even be fatal. If you pass out because of a low sugar reaction or cannot swallow, someone will have to give an injection of glucagon to treat the low sugar reaction. You may need to go to the emergency room.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

metformin-rosiglitazone May Interact with Other Medications

Oral tablet

Metformin/rosiglitazone can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol interaction

You should limit how much alcohol you drink while taking metformin. Alcohol can lower or raise your blood sugar levels, and it may also increase your risk of lactic acidosis.

Medications that might interact with this drug

Dye or contrast used during an x-ray procedure

Dyes can increase your risk of lactic acidosis.

These drugs include:

  • radiopaque contrast agents

Drugs for high blood pressure in the arteries of the lungs or heart

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • bosentan

Cholesterol drugs

This drug can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • gemfibrozil

Pain drugs

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include salicylates, such as:

  • aspirin
  • magnesium salicylate
  • salsalate

Certain pain drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • morphine

Antibiotics

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • sulfacetamide
  • sulfadiazine
  • sulfamethoxazole/trimethoprim
  • sulfasalazine
  • sulfisoxazole
  • vancomycin

Water pills (diuretics and thiazide diuretics)

Diuretics can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • amiloride 
  • furosemide
  • triamterene

Thiaziade diuretics can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • chlorothiazide
  • chlorthalidone
  • hydrochlorothiazide
  • indapamide
  • metolazone

Heart drugs

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • digoxin

Heart rate problems drugs

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • procainamide
  • quinidine
  • dofetilide

Heartburn drugs

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include histamine H2 blockers, such as:

  • cimetidine
  • ranitidine

Other diabetes drugs

These drugs can interact with metformin/rosiglitazone and cause low blood sugar.

These drugs include:

  • oral diabetes drugs
  • insulin

Rifamycins to treat infection

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • rifabutin
  • rifampin
  • rifapentine
  • rifaximin

Oral steroids

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • dexamethasone
  • hydrocortisone
  • methylprednisolone
  • prednisone
  • prednisolone

Antipsychotic and antinausea drugs

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • chlorpromazine
  • fluphenazine
  • perphenazine
  • prochlorperazine
  • thioridazine

Thyroid drugs

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • levothyroxine

Estrogens

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • conjugated estrogens
  • estradiol

Oral birth control pills

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

Seizure medications

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • fosphenytoin
  • phenytoin

Heart and blood pressure drugs

Some high blood pressure and heart drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • calcium channel blockers, such as:
    • amlodipine
    • diltazem
    • felodipine
    • isradipine
    • nicardipine
    • nifedipine
    • nisoldipine
    • verapamil

Other drugs used to treat high blood pressure may increase or decrease the effect of metformin/rosiglitazone. They may also mask the symptoms of low blood sugar.

These drugs include:

  • beta blockers, such as:
    • carvedilol
    • propranolol
    • labetalol
  • clonidine
  • reserpine

Tuberculosis drugs

These drugs can cause high blood sugar when taken with metformin/rosiglitazone.

These drugs include:

  • isoniazid

Guanethedine

This medication may mask symptoms of low blood sugar.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
macular edema
People with macular edema

You shouldn’t take this drug if you have the diabetic eye disease macular edema. This drug may make your condition worse.

heart failures
People with heart failure

Rosiglitazone can cause your body to retain fluid, which leads to swelling (edema) and weight gain. Extra body fluid can make some heart problems worse or cause heart failure. Don’t take this drug if you have severe heart failure.

kidney disease
People with kidney disease

Metformin is removed from your body by your kidneys. If your kidneys aren’t working as well, this drug may build up in your body and cause lactic acidosis. Your doctor may start you at a lower dose and slowly increase your dose if needed.

liver disease
People with liver disease

Liver disease may raise the risk of lactic acidosis. Rosiglitazone may increase the risk of liver failure. You shouldn’t take this drug if you have liver disease.

bone fractures
People with bone fractures

Rosiglitazone can lead to broken bones, especially in females. Your doctor may recommend other treatments to help keep your bones healthy.

anemia
People with anemia

Rosiglitazone can decrease your red blood cell levels and lead to anemia. If you already have anemia, this drug can make it worse.

type 1 diabetes
People with type 1 diabetes or diabetic ketoacidosis

You shouldn’t use this drug if you have type 1 diabetes or diabetic ketoacidosis.

SECTION 4 of 4

How to Take metformin-rosiglitazone (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Type 2 diabetes

Brand: Avandamet

Form: Oral tablet
Strengths:
  • 500 mg metformin/2 mg rosiglitazone
  • 500 mg metformin/4 mg rosiglitazone
  • 1,000 mg metformin/2 mg rosiglitazone
  • 1,000 mg metformin/4 mg rosiglitazone

Generic: metformin/rosiglitazone

Form: Oral tablet
Strengths:
  • 500 mg metformin/2 mg rosiglitazone
  • 500 mg metformin/4 mg rosiglitazone
  • 1,000 mg metformin/2 mg rosiglitazone
  • 1,000 mg metformin/4 mg rosiglitazone
Adult dosage (ages 18–64 years)
  • When diabetes isn’t controlled with diet and exercise alone: 
    • The starting dose is 500 mg metformin/2 mg rosiglitazone  taken by mouth once or twice per day with meals.
    • If your blood sugar levels aren’t controlled after 4 weeks, your dose may be increased by 500 mg metformin/2 mg rosiglitazone per day. Your doctor may keep increasing your dose until your blood sugar levels are controlled or you reach the maximum dose of metformin/rosiglitazone.
  • When diabetes isn’t controlled on metformin alone: 
    • The starting dose is 4 mg rosiglitazone per day plus your current dose of metformin taken in divided doses with food.
  • When diabetes isn’t controlled on rosiglitazone alone: 
    • The starting dose is 1,000 mg metformin per day plus your current dose of rosiglitazone given in divided doses with food.
  • People who are switching from combination therapy of metformin and rosiglitazone as separate tablets:
    • Use your current dose of metformin and rosiglitazone.
  • Maximum dose: The maximum dose of metformin/rosiglitazone is 2,000 mg/8 mg per day. This is taken as 1,000 mg metformin/4 mg rosiglitazone two times per day.
Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

As you age, your kidneys and liver may not work as well as they did when you were younger. This may make you more sensitive to the effects of this medication. Your doctor may reduce your starting dose and may adjust your dose more slowly.

People 80 years of age and older shouldn’t start taking metformin unless they have normal kidney function. You have a higher risk of lactic acidosis. If you’re over 80 years of age and taking metformin, you shouldn’t take the maximum dose.

Special considerations

People with kidney disease: Serum creatinine level of 1.5 mg/dL and below in males or 1.4 mg/dL and below in females, or abnormal creatinine clearance: you shouldn’t use metformin/rosiglitazone.

People with liver disease: People with liver problems shouldn’t take this drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug comes with serious risks if you don't take it as prescribed.

If you don't take it at all or don’t take it on schedule

You may have high blood sugar levels and your diabetes control can get worse. Over time, high blood sugar levels can harm your eyes, kidneys, nerves, or heart. Severe issues include heart attack, stroke, blindness, kidney failure and dialysis, and limb amputations.

If you take too much

If you take too much of this drug, you may experience low blood sugar (hypoglycemia). Symptoms include:

  • shakiness
  • nervousness or anxiety
  • sweating, chills, and clamminess
  • irritability or impatience
  • confusion, including delirium
  • fast heart rate
  • lightheadedness or dizziness
  • hunger and nausea
  • sleepiness
  • blurred or impaired vision
  • tingling or numbness in your lips or tongue
  • headaches
  • weakness or fatigue
  • anger, stubbornness, or sadness
  • lack of coordination
  • nightmares or crying out during your sleep
  • seizures
  • loss of consciousness

If you have a low blood sugar reaction, you need to treat it.

  • For mild hypoglycemia (55–70 mg/dL), treatment is 15–20 grams of glucose (a type of sugar). You need to eat or drink one of the following:
    • 3–4 glucose tablets
    • a tube of glucose gel
    • ½ cup of juice or regular, non-diet soda
    • 1 cup of nonfat or 1% cow’s milk
    • 1 tablespoon of sugar, honey, or corn syrup
    • 8–10 pieces of hard candy, such as lifesavers
  • Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, then repeat the above treatment again.
  • Once your blood sugar is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later. 

What to do if you miss a dose

If you miss a dose of this drug, take it as soon as you remember. If it’s just a few hours before the time for your next dose, then only take one dose at that time.

Don’t take double doses to make up for a missed dose. This could cause toxic side effects.

How to tell if the drug is working

If this drug is working, your symptoms of high blood sugar should decrease. You may not urinate as often or be as thirsty or hungry.

Your blood sugar readings will be lower and may be in the target range for people with type 2 diabetes. The target ranges are as follows:

  • Blood sugar before a meal (preprandial plasma glucose): between 70–130 mg/dL.
  • Blood sugar 1–2 hours after starting of a meal (postprandial plasma glucose): less than 180 mg/dL.

This drug is used for long-term treatment.

Take this drug with meals

This will reduce your chance of diarrhea, nausea, and upset stomach.

Store this drug carefully

  • Store this drug at room temperature between 59°F (15°C) and 86°F (30°C).
  • Keep this drug in the original container to protect it from light.
  • Keep the bottle closed tightly and keep tablets dry.
  • Don’t freeze this drug.
  • Keep it away from high temperature.
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry your medication with you or in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt your medication.
  • You may need to show airport staff your pharmacy’s label to clearly identify the medication. Keep the original prescription label with you when traveling.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.
  • Lancets need to be used to test your blood sugar. Check for special rules about traveling with lancets.

Self-management

Your doctor may have you regularly test your blood sugar levels at home.

You’ll need to learn how to do the following:

  • use a blood glucose monitor to test your blood sugar regularly at home
  • recognize the signs and symptoms of high and low blood sugar
  • treat high and low blood sugar reactions

To do this you will need the following:

  • sterile alcohol wipes
  • lancing device and lancets (a needle used to obtain drops of blood from your finger to test your blood sugar)
  • blood sugar test strips
  • blood glucose monitoring machine
  • needle container for safe disposal of lancets

Clinical monitoring

Before starting and during your treatment with this drug, your doctor may check your:

  • blood sugar levels
  • glycosylated hemoglobin (A1C) levels. This test measures your blood sugar control over the last 2–3 months.
  • liver function
  • kidney function
  • blood cell counts and vitamin B-12 levels

Your diet

This drug, when combined with lifestyle changes (diet, exercise, and not smoking), can help lower your blood sugar. Follow the nutrition plan that your doctor, registered dietician, or diabetes educator recommended.

Hidden costs

In addition to the medicine, you’ll need to purchase the following:

  • sterile alcohol wipes
  • lancing device and lancets (a needle used to obtain drops of blood from your finger to test your blood sugar)
  • blood sugar test strips
  • blood glucose monitoring machine
  • needle container for safe disposal of lancets

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for this drug.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 25, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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