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It is important to be aware of the potential risks and necessary precautions when using pioglitazone and metformin. Below is a detailed overview of key safety information and warnings:

• Heart Failure Risks: Pioglitazone may occasionally lead to or exacerbate heart failure. Notify your healthcare provider immediately if you experience symptoms like difficulty breathing, swelling in your ankles or feet, unusual fatigue, or unexpected weight gain. Those diagnosed with certain forms of heart failure should avoid this medication. Discuss your medical history concerning heart failure with your doctor before starting this treatment.

• Lactic Acidosis Warning: Excessive levels of metformin can sometimes lead to lactic acidosis, a severe and potentially life-threatening condition. Higher risk factors include advanced age, kidney or liver issues, dehydration, heart failure, significant alcohol consumption, undergoing surgery, or receiving X-ray/scan procedures with iodinated contrast. Certain medications may also increase risk. Your healthcare provider may recommend pausing the medication temporarily in some situations. For further guidance, consult with your doctor or pharmacist.

• Emergency Measures for Lactic Acidosis: Discontinue the medication immediately and seek urgent medical attention if you exhibit symptoms of lactic acidosis, such as extreme fatigue, dizziness, severe sleepiness, chills, bluish or cold skin, muscle pain, rapid or difficult breathing, irregular heart rhythms, or stomach discomfort accompanied by nausea, vomiting, or diarrhea.

These precautions ensure safe and effective use of the medication. Always communicate openly with your healthcare provider about any pre-existing conditions or concerns.

You may experience some mild side effects such as nausea, vomiting, upset stomach, diarrhea, weakness, sore throat, muscle pain, weight gain, tooth problems, or a metallic taste in your mouth. These effects are generally temporary but if they persist or worsen, consult your healthcare provider.

Be attentive to more serious symptoms like returning stomach issues after the initial days of treatment, which could signal lactic acidosis. Also, report symptoms such as new or worsening vision problems, bone fractures, reddish urine, urgent or painful urination, and signs of liver disease, including persistent nausea or vomiting, dark urine, yellowing of the eyes or skin, and abdominal pain.

While this medication typically does not cause low blood sugar, it can occur when combined with other diabetes medications, excessive alcohol intake, intense exercise, or insufficient calorie intake. To prevent this, maintain regular meal schedules and avoid skipping meals. Symptoms of low blood sugar include sudden sweating, shaking, rapid heartbeat, hunger, blurred vision, dizziness, or tingling in the hands or feet. Carry glucose tablets or gel to manage these symptoms promptly.

High blood sugar symptoms, such as increased thirst and urination, should also be reported to your doctor, as adjustments to your medication or lifestyle may be necessary. Although a severe allergic reaction to this medication is rare, seek immediate medical attention if you experience a rash, itching or swelling, especially of the face, tongue, or throat, dizziness, or difficulty breathing.

This summary does not include all possible side effects. For any other unexpected effects, contact your healthcare provider.