Competact 15 mg/850 mg film-coated tablets

• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Competact is and what it is used for
2. What you need to know before you take Competact
3. How to take Competact
4. Possible side effects
5 How to store Competact
6. Contents of the pack and other information

• if you are allergic to pioglitazone, metformin or any of the other ingredients of this medicine (listed in section 6).
• if you have heart failure or have had heart failure in the past.
• if you recently had a heart attack, have severe circulatory problems including shock, or breathing difficulties.
• if you have liver disease.
• if you drink alcohol excessively (either every day or only from time to time).
• if you have uncontrolled diabetes, with for example severe hyperglycaemia (high blood glucose), nausea, vomiting, diarrhoea, rapid weight loss, lactic acidosis (see section“Risk of lactic acidosis”) or ketoacidosis. Ketoacidosis is a condition in which substances called 'ketone bodies' accumulate in the blood and which can lead to diabetic pre-coma. Symptoms include stomach pain, fast and deep breathing, sleepiness or your breath developing an unusual fruity smell.
• if you have or have ever had bladder cancer.
• if you have blood in your urine that your doctor has not checked.
• if you have severely reduced kidney function.
• if you have a severe infection or are dehydrated.
• if you are going to have a certain type of X-ray with an injectable dye, talk to your doctor as you must stop taking Competact for a certain period of time before and after the examination.
• if you are breast-feeding.

Talk to your doctor or pharmacist before taking Competact (see also section 4).

• if you have a problem with your heart. Some patients with long-standing type 2 diabetes mellitus and heart disease or previous stroke who were treated with pioglitazone and insulin together experienced the development of heart failure. Inform your doctor as soon as possible if you experience signs of heart failure such as unusual shortness of breath or rapid increase in weight or localised swelling (oedema).
• if you retain water (fluid retention) or have heart failure problems in particular if you are over 75 years old. If you take anti-inflammatory medicines which can also cause fluid retention and swelling, you must also tell your doctor.
• if you have a special type of diabetic eye disease called macular oedema (swelling of the back of the eye), talk to your doctor if you notice any change to your vision.
• if you have cysts on your ovaries (polycystic ovary syndrome). There may be an increased possibility of becoming pregnant because you may ovulate again when you take Competact. If this applies to you, use appropriate contraception to avoid the possibility of an unplanned pregnancy.
• if you have a problem with your liver. Before you start taking Competact you will have a blood sample taken to check your liver function. This check should be repeated at intervals. Inform your doctor as soon as possible if you develop symptoms suggesting a problem with your liver (like feeling sick without explanations, vomiting, stomach ache, tiredness, loss of appetite and/or dark urine) as your liver function should be checked.

You may also experience a reduction in blood count (anaemia).

Competact may cause a very rare, but very serious side effect called lactic acidosis, particularly if your kidneys are not working properly. The risk of developing lactic acidosis is also increased with uncontrolled diabetes, serious infections, prolonged fasting or alcohol intake, dehydration (see further information below), liver problems and any medical conditions in which a part of the body has a reduced supply of oxygen (such as acute severe heart disease).

If any of the above apply to you, talk to your doctor for further instructions.

Talk to your doctor promptly for further instructions if:

• You are known to suffer from a genetically inherited disease affecting mitochondria (the energy-producing components within cells) such as MELAS syndrome (Mitochondrial Encephalopathy, myopathy, Lactic acidosis and Stroke-like episodes) or Maternal inherited diabetes and deafness (MIDD).
• You have any of these symptoms after starting metformin: seizure, declined cognitive abilities, difficulty with body movements, symptoms indicating nerve damage (e.g. pain or numbness), migraine and deafness.

Stop taking Competact for a short time if you have a condition that may be associated with dehydration (significant loss of body fluids) such as severe vomiting, diarrhoea, fever, exposure to heat or if you drink less fluid than normal. Talk to your doctor for further instructions.

Stop taking Competact and contact a doctor or the nearest hospital immediately if you experience some of the symptoms of lactic acidosis, as this condition may lead to coma.

Symptoms of lactic acidosis include:

• vomiting
• stomach ache (abdominal pain)
• muscle cramps
• a general feeling of not being well with severe tiredness
• difficulty in breathing
• reduced body temperature and heartbeat

Lactic acidosis is a medical emergency and must be treated in a hospital.

During treatment with Competact, your doctor will check your kidney function at least once a year or more frequently if you are elderly and/or if you have worsening kidney function.

If you need to have major surgery you must stop taking Competact during and for some time after the procedure. Your doctor will decide when you must stop and when to restart your treatment with Competact.

If you take Competact with other medicines for diabetes, it is more likely that your blood sugar could fall below the normal level (hypoglycaemia). If you experience symptoms of hypoglycaemia such as weakness, dizziness, increased sweating, fast heart-beating, vision disorders or difficulty in concentration, you should take some sugar to increase your blood sugar level again. Ask your doctor or pharmacist for more information if you are not sure how to recognise this. It is recommended that you carry some sugar lumps, sweets, biscuits or sugary fruit juice

A higher number of bone fractures was seen in patients, particularly women taking pioglitazone. Your doctor will take this into account when treating your diabetes.

Use in children and adolescents under 18 years is not recommended.

If you need to have an injection of a contrast medium that contains iodine into your bloodstream, for example in the context of an X-ray or scan, you must stop taking Competact before or at the time of the injection. Your doctor will decide when you must stop and when to restart your treatment with Competact.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. You may need more frequent blood glucose and kidney function tests, or your doctor may need to adjust the dose of Competact. It is especially important to mention the following:

• gemfibrozil (used to lower cholesterol)
• rifampicin (used to treat tuberculosis and other infections)
• cimetidine (used to reduce stomach acid)
• glucocorticoids (used to treat inflammation)
• beta-2-agonists (used to treat asthma)
• medicines which increase urine production (diuretics)
• medicines used to treat pain and inflammation (NSAID and COX-2-inhibitors, such as ibuprofen and celecoxib)
• certain medicines for the treatment of high blood pressure (angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists)

Avoid excessive alcohol intake while taking Competact since this may increase the risk of lactic acidosis (see section “Risk of lactic acidosis”).

• you must tell your doctor if you are pregnant, think you may be pregnant or are planning to have a baby. Competact is not recommended in pregnancy. If you wish to become pregnant, your doctor will advise you to discontinue this medicine.
• do not use Competact if you are breastfeeding or are planning to breast-feed (see section “Do not take Competact”).

This medicine will not affect your ability to drive or use machines but take care if you experience abnormal vision.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

If you accidentally take too many tablets, or if someone else or a child takes your medicine, talk to a doctor or pharmacist immediately. Your blood sugar could fall below the normal level and can be increased by taking sugar. It is recommended that you carry some sugar lumps, sweets, biscuits or sugary fruit juice.

If you have taken more Competact that you should have, you may experience lactic acidosis (see section “Risk of lactic acidosis”).

Take Competact daily as prescribed. However if you miss a dose, skip the missed dose and just carry on with the next dose as normal. Do not take a double dose to make up for a forgotten tablet.

Competact should be used every day to work properly. If you stop using Competact, your blood sugar may go up. Talk to your doctor before stopping this treatment.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly to:

or search for MHRA Yellow Card in the Google Play or Apple App Store

By reporting side effects you can help provide more information on the safety of this medicine.

• The active substances are pioglitazone and metformin hydrochloride. Each tablet contains 15 mg pioglitazone (as hydrochloride) and 850 mg metformin hydrochloride.
• The other ingredients are microcrystalline cellulose, povidone (K30), croscarmellose sodium magnesium stearate, hypromellose, macrogol 8000, talc and titanium dioxide (E171).

The film-coated tablets (tablets) are white to off white, oblong, convex, embossed ‘15 / 850’ on one face and ‘4833M’ on the other. They are supplied in aluminium/aluminium blisters in packs of 56 tablets.