Glimy MP is a combination of three medicines: glimepiride, metformin and pioglitazone. Such an irrational combination is not permitted to be sold in any advanced country. The side effects of pioglitazone alone may include the following: cardiovascular disorders, heart failure, liver & biliary disorders, abnormal SGPT/SGOT/CPK levels, visual disturbance, upper respiratory tract infection, weight gain, hypoaesthesia, sinusitis, pharyngitis, myalgia, dyspnoea, new or worsening of diabetic macular oedema and bladder cancer.
When taken with metformin the additional side effects may include the following: anaemia, oedema, weight gain, headache, haematuria (blood in urine), visual disturbance, joint pain (arthralgia) and impotence. When taken with glimepiride the additional side effects may include: Weight gain, dizziness, flatulence and oedema.
Thus if all the three medicines are taken then side effects are more than its benefits. Hence pioglitazone alone is given particularly in obese patients only when metformin cannot be given or is not tolerated. Pioglitazone in combination with metformin is given when metformin alone is not adequate to control blood sugar. Pioglitazone in combination with glimepiride is given when the patient cannot tolerate metformin. However the three drugs i.e. glimepiride, metformin and pioglitazone are never given together. I may add here that the innovator of pioglitazone, Takeda Pharmaceuticals, has issued additional guidelines and warnings on the use of the drug in diabetes. Briefly it states that: (a) Pioglitazone is not for all diabetics. (b) It can cause fluid retention that can precipitate or worsen congestive heart failure (CHF). There is 39 per cent increase in the risk of CHF in patients taking pioglitazone compared to those who are not on this medicine and (c) LFTs (liver function tests) must be done before starting pioglitazone and periodically thereafter. Patients must be instructed to consult their doctors if there is rapid weight gain, shortness of breath, nausea, vomiting, abdominal pain, tiredness, loss of appetite, dark urine or yellowing of skin.