Drug interactions
Metformin-pioglitazone + Ranolazine
Severity: Moderate
Metformin-pioglitazone and Ranolazine: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Ranolazine inhibits renal and hepatic transporters involved in metformin clearance, which raises metformin plasma concentrations. Higher exposure increases the risk of gastrointestinal intolerance and, in susceptible patients, lactic acidosis.
What this interaction means in plain words
Metformin-pioglitazone and Ranolazine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Metformin-pioglitazone belongs to Endocrine; Ranolazine belongs to Cardiovascular.
Why it happens
Ranolazine inhibits OCT2 and MATE1 transporters, reducing renal tubular secretion of metformin.
What to do
Limit the metformin dose to 1700 mg/day when given with ranolazine 1000 mg twice daily. Monitor glycemic control, renal function and symptoms of lactic acidosis.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Metformin-pioglitazone
Other interactions of Ranolazine
- Adagrasib + Ranolazine Contraindicated
- Amobarbital + Ranolazine Contraindicated
- Apalutamide + Ranolazine Contraindicated
- Butabarbital + Ranolazine Contraindicated
- Carbamazepine + Ranolazine Contraindicated
- Clarithromycin + Ranolazine Contraindicated
Frequently asked questions
Can I take Metformin-pioglitazone with Ranolazine?
MediHelp rates the interaction as moderate. Metformin-pioglitazone and Ranolazine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Ranolazine inhibits renal and hepatic transporters involved in metformin clearance, which raises metformin plasma concentrations. Higher exposure increases the risk of gastrointestinal intolerance and, in susceptible patients, lactic acidosis.
How serious is the interaction between Metformin-pioglitazone and Ranolazine?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Limit the metformin dose to 1700 mg/day when given with ranolazine 1000 mg twice daily. Monitor glycemic control, renal function and symptoms of lactic acidosis.
What other medicines interact with Metformin-pioglitazone?
MediHelp also lists interactions of Metformin-pioglitazone with, for example, Contrast media, Diatrizoate meglumine / diatrizoate, Diatrizoate. The full list is on the Metformin-pioglitazone page.
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