Avandamet: Uses, Side Effects and Dosage

ABOUT THIS MEDICATION

What the medication is used for:

AVANDAMET^® (ah-VAN-duh-met) is a medicine used in addition to diet and exercise to lower blood sugar in patients with type 2 diabetes (non-insulin dependent) when all other diabetes medicines taken orally (by mouth) have not lowered blood sugar enough or are not appropriate.

Before starting AVANDAMET^®, your doctor will discuss the possible benefits and possible side effects of AVANDAMET^® to decide if AVANDAMET^® is right for you. Your doctor will ask you to read and sign a form indicating you understand the cardiovascular risks of AVANDAMET^®.

In order for AVANDAMET^® to be effective, you should continue to exercise and follow the diet recommended for your diabetes while taking AVANDAMET^®.

People who have diabetes have problems with insulin. Insulin is produced by an organ called the pancreas (PAN-kree-us). Inside the pancreas are special cells called beta-cells that actually make insulin. Insulin is a hormone (body’s own natural chemical) that allows the body's tissues to absorb glucose (known as "sugar") from the bloodstream to provide the body energy.

People with Type 2 diabetes do not make enough insulin, or the body tissues become less sensitive to insulin. When the tissues do not respond normally to insulin, it is as if they cannot “hear” the signals insulin sends out – this is called "insulin resistance."

With diabetes, sugar (glucose) builds up in the blood. This can lead to serious medical problems including kidney damage, heart disease, loss of limbs, and blindness. The main goal of treating diabetes is to lower your blood sugar to a normal level. Lowering and controlling blood sugar may help prevent or delay complications of diabetes such as heart disease, kidney disease or blindness.

What it does:

AVANDAMET^® combines two glucose-lowering medicines, rosiglitazone (AVANDIA^®) and metformin, together in one tablet. These two medicines work together to help you achieve better blood sugar control. Rosiglitazone helps your body use its own insulin better by making the tissues more sensitive to insulin. The tissues are better able to "hear" the signals insulin sends out. That means the tissues will absorb sugar more easily. Metformin helps to lower the amount of sugar made by the liver.

Together, these medicines keep the amount of sugar in your blood at a more normal level.

When it should not be used:

• If you have or have had heart problems or heart failure (the heart cannot pump enough blood to the body's other organs), talk to your doctor. One of the two medicines that make up AVANDAMET^®, rosiglitazone, can cause your body to keep extra fluid (fluid retention), which can make some heart problems worse, lead to heart failure, swelling and weight gain.
• If you have kidney disease or impairment (reduced kidney function).
• If you are allergic to AVANDAMET^® or any of its components.
• If you have diabetic ketoacidosis (dangerously high levels of ketones, which signals the body doesn't have enough insulin).

• If you have had a condition called lactic acidosis. Lactic acidosis is caused by a build-up of lactic acid in the blood. Because of the possibility of lactic acidosis, you should not take AVANDAMET^® if:

  • You drink alcohol excessively (all the time or short-term “binge” drinking).
  • You are seriously dehydrated (have lost a large amount of body fluids).
  • You have a severe infection or experience serious physical trauma, including surgery or while recovering from surgery.
  • You develop a serious condition such as a heart attack, stroke or have severe heart or breathing difficulties.
  • You are 80 years of age or older and have NOT had your kidney function tested.
• If you have serious liver problems.
• If you have Type I diabetes – this needs different treatment.

• If you are pregnant or breastfeeding.

AVANDAMET^® therapy will need to be stopped temporarily if you are going to have certain x-ray procedures with injectable contrast agents.

What the medicinal ingredients are:

AVANDAMET^® tablets contain two active ingredients, rosiglitazone maleate and metformin hydrochloride, in one tablet.

What the nonmedicinal ingredients are:

hydroxypropyl methylcellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, polyethylene glycol 400, povidone 29-32, sodium starch glycolate, titanium dioxide and one or more of the following: red and yellow iron oxides.

What dosage forms it comes in:

rosiglitazone maleate/metformin hydrochloride tablets 1 mg/500 mg, 2 mg/500 mg, 4 mg/500 mg

2 mg/1000 mg, 4 mg/1000 mg.

WARNINGS AND PRECAUTIONS

Serious Warnings and Precautions

• AVANDAMET^®, which contains rosiglitazone, may

  increase the risk of serious heart problems, including:

  • heart failure
  • angina (chest pain)
  • heart attack (myocardial infarction)
  • fluid retention (with or without rapid weight gain)

• AVANDAMET^® should not be used if you have or have

  had heart problems.

Before you use AVANDAMET^®, talk to your doctor about other options to treat your diabetes.

Before, or while taking AVANDAMET^®, talk to your doctor about all your medical conditions, including if:

• you have experienced edema (swelling in the wrists, hands, feet or ankles).
• you have been diagnosed with angina (chest pain) or have had a heart attack.
• you have heart-related risks, including cigarette smoking, high blood pressure, high cholesterol, or a family history of heart attack.
• you are taking nitrate medicines (such as nitroglycerin or isosorbide dinitrate).
• you have a type of diabetic eye disease called macular edema (swelling in the back of the eye).
• you have liver problems.
• you are breastfeeding,
• you are pregnant or planning to become pregnant.

• you are not near menopause but not ovulating (e.g., you are a patient with polycystic ovary syndrome).

  AVANDAMET^® could make you ovulate again, which means you could get pregnant. Talk to your doctor about

  effective methods of birth control (e.g., hormonal contraceptive pills).

  • you are going to have any surgery or specialized x-ray procedures that require injection of contrast agents (substances that help physicians see the tissues more clearly). AVANDAMET^® therapy will need to be stopped temporarily in such instances.

Broken bones usually in the hand, upper arm or foot, have been seen in people taking rosiglitazone, one of the active ingredients of AVANDAMET^®. Talk to your doctor about the risk of fracture.

Decreases in spine and hip bone mineral density (a measure of bone strength, based on the amount of calcium and other minerals in your bones) have been reported in men and women taking rosiglitazone.

Muscle problems, including muscle tenderness, weakness, or pain that you cannot explain, have been seen in people taking rosiglitazone, one of the active ingredients of AVANDAMET^®. Talk with your doctor if you experience these symptoms. If you experience brownish or discoloured urine with your muscle problems, stop taking AVANDAMET^® and call your doctor right away.

The safety and effectiveness of AVANDAMET^® have not been established in children under 18 years of age, therefore AVANDAMET^® is not recommended for use in these patients.

AVANDAMET^® is not approved for use with insulin therapy, therefore AVANDAMET^® is not recommended for use with insulin.

AVANDAMET^® is not approved for use with a sulfonylurea, therefore AVANDAMET^® is not recommended for use with a sulfonylurea.

INTERACTIONS WITH THIS MEDICATION

AVANDAMET^® may affect how other medicines work, and some medicines may affect how AVANDAMET^® works. Drugs that may interact with the two active ingredients in AVANDAMET^® (rosiglitazone and metformin) include: digoxin and quinidine (used to treat heart failure and arrhythmias), gemfibrozil (used to lower cholesterol and triglyceride levels in your blood), methotrexate (used to treat psoriasis and rheumatoid arthritis), morphine (used to relieve severe pain), ranitidine (used to treat ulcers and gastroesophageal reflux disease (GERD)), rifampin (used to treat tuberculosis).

Keep a list of all the medicines you take and tell your doctor and pharmacist about every medication you take. This means both prescription medications (the ones your doctor writes for you) and over-the-counter medications (the ones you buy in the drugstore, like cold or allergy medicines), or natural health products (herbal medicines).

PROPER USE OF THIS MEDICATION

Usual dose:

The usual starting dose of AVANDAMET^® depends on your previous treatment with metform (GLUCOPHAGE) and rosiglitazone (AVANDIA^®). Your doctor will decide on the dose of AVANDAMET^® that is suitable for you.

AVANDAMET^® should be taken by mouth and with meals. Your doctor may need to adjust your dose until your blood sugar is better controlled. AVANDAMET^® can begin to work 1 or 2 weeks after you start taking it. It may take 2-3 months to see the optimal effects.

Test your blood sugar regularly as your doctor tells you.

Remember: this medicine has been prescribed only for you. Do not give it to anybody else.

Take your AVANDAMET^® each day, as instructed by your doctor. AVANDAMET^® can help control your blood sugar levels only if you take it regularly.

Overdose:

Taking too much of any medicine can be dangerous.

Missed Dose:

Take one dose as soon as you remember. Then take the next dose at the usual time. Never take extra doses in one day to make up for a missed dose the day before. If you miss a whole day of AVANDAMET^®, just take your dose as usual the next day. Don’t try to make it up by taking extra tablets.

Recommended clinical and laboratory tests while taking AVANDAMET^®:

Your doctor may do additional blood sugar tests to see how well AVANDAMET^® is working.

Your doctor may conduct various blood or laboratory tests to monitor your health and liver before you start AVANDAMET^® and repeat the tests periodically while you are on AVANDAMET^®.

Your doctor should check your eyes regularly. Rarely, some patients have experienced vision changes due to swelling in the back of the eye while taking AVANDAMET^®.

SIDE EFFECTS AND WHAT TO DO ABOUT THEM

Very common side effects (could affect one in 10 people or more):

• Symptoms of an upset stomach such as nausea, vomiting, diarrhea, and stomach pain. If these side effects occur, they usually occur during the first few weeks of therapy. Taking your AVANDAMET^® with meals can help reduce these side effects.

Common side effects (could affect up to one in 10 people):

• Anemia (low red blood cell count) which may make you feel very weak or tired.
• Chest pain (angina)
• Heart failure or pulmonary edema (fluid accumulation in the lungs) . Symptoms of heart failure include shortness of breath, getting tired easily after light physical activity such as walking, unusual tiredness, waking up short of breath at night, swollen ankles or feet, and an unusually rapid increase in weight. Symptoms of fluid in the lungs are breathlessness, which may be very severe and usually worsens on lying down. Stop taking AVANDAMET^® and call your doctor right away if you experience these symptoms.
• Constipation.
• Edema (fluid retention or swelling) which could lead to or worsen heart failure. If you notice swelling in your extremities (arms and legs, hands and feet), an unusually rapid increase in weight, or if you experience unusual tiredness, trouble breathing or shortness of breath, call your doctor. These symptoms, although not specific, may signal heart problems or heart failure. Pay closer attention to these symptoms if you are using the higher dose of rosiglitazone (8 mg) in AVANDAMET^® as fluid retention is more common.
• Broken bones usually in the hand, upper arm or foot . Talk to your doctor about the risk of fracture.
• A small increase in total cholesterol levels. Total cholesterol is made up of "good cholesterol" (HDLc) and "bad cholesterol" (LDLc) and it is the balance of these that is more important than the total level. AVANDAMET^® does not affect the balance of good and bad cholesterol. If you have any concerns about your cholesterol levels, you should speak to your doctor.
• Low blood sugar (hypoglycemia). There is a low risk of hypoglycemia with AVANDAMET^®. Dizziness, lack of energy, drowsiness, headache, trembling, sweating, or hunger may mean that your blood sugar is too low. This can happen if you skip meals, drink alcohol, use another medicine that lowers blood sugar, exercise (particularly hard or long), or if you have certain medical problems. Call your doctor if you feel that your symptoms of low blood sugar are uncomfortable.
• A strange or metallic taste in the mouth

In case of drug overdose, contact a health care practitioner, hospital emergency department or regional Poison Control Centre immediately, even if there are no symptoms.

• Increased weight. Tell your doctor if you gain a lot of weight in a short period of time.

Rare side effects (could affect up to one in 1,000 people):

• Liver problems. If you experience nausea, vomiting, stomach pain, lack of appetite, tiredness, dark urine, or yellowing of the skin, stop taking AVANDAMET^® and call your doctor right away.
• Blurred vision due to swelling (or fluid) in the back of the eye.

Very rare side effects (could affect up to one in 10,000 people):

• Lactic acidosis

  Metformin, one of the active ingredients in AVANDAMET^®, can cause a serious side effect called lactic acidosis. This is caused by a build-up of lactic acid in your blood. This build-up can cause serious damage. Lactic acidosis is a medical emergency that must be treated in a hospital.

• Allergic reactions, which may include hives or rash

  (which may be itchy), or more serious symptoms which may occur suddenly, such as swelling of the face, lips, mouth, tongue or throat (which may cause difficulty in swallowing or breathing). Stop taking AVANDAMET^® and call your doctor right away if you experience these symptoms.

• Breakthrough bleeding (unexpected vaginal bleeding or spotting) while using oral contraceptives, or generally, if you experience any symptoms that persist or become troublesome, these should be discussed with your doctor.
• Muscle problems. If you experience muscle tenderness, weakness, or pain that you cannot explain, talk with your doctor. If you experience brownish or discoloured urine with your muscle problems, stop taking AVANDAMET^® and call your doctor right away.
• Problems related to Vitamin B12 deficiency.

You may experience swelling of the parotid gland (salivary glands located over the jaw, in front of the ears).

This is not a complete list of side effects. If you experience any unexpected effects while taking AVANDAMET^®, contact your doctor or pharmacist.

HOW TO STORE IT

Store AVANDAMET^® at room temperature (15º C to 30º C), out of the reach of children.

REPORTING SUSPECTED SIDE EFFECTS

You can report any suspected adverse reactions associated with the use of health products to the Canada Vigilance Program by one of the following 3 ways:

• Report online at www.healthcanada.gc.ca/medeffect
• Call toll free at 1-866-234-2345

• Copmlete a Canada Vigilance Reporting Form and:

  • Fax toll-free to 1-866-678-6789, or

  • Mail to: Canada Vigilance Program

    Health Canada

    Postal Locator 0701C Ottawa, ON K1A 0K9

Postage paid labels, Canada Vigilance Reporting Form and the adverse reaction reporting guidelines are available on the MedEffect™ Canada Web site at www.healthcanada.gc.ca/medeffect.

NOTE: Should you require information related to the management of side effects, contact your health professional. The Canada Vigilance Program does not provide medical advice.

MORE INFORMATION

This document plus the full product monograph, prepared for health professionals can be found at:

http://www.gsk.ca

or by contacting the sponsor,

GlaxoSmithKline Inc

7333 Mississauga Road

Mississauga, Ontario

L5N 6L4

1-800-387-7374

Last revised: January 26, 2012

^© 2012 GlaxoSmithKline, All Rights Reserved ^®AVANDAMET is a registered trademark, used under license by GlaxoSmithKline Inc.

^®AVANDIA is a registered trademark, used under license by GlaxoSmithKline Inc.