Short answer: Duetact is one tablet taken once daily with the first main meal. The label starts at 30 mg/2 mg or 30 mg/4 mg, depending on current treatment, and raises it gradually. The maximum is 45 mg pioglitazone and 8 mg glimepiride a day. It is taken at least 4 hours before colesevelam. The Medication Guide says not to take two doses at once after a missed dose.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Duetact is approved for: Duetact combines pioglitazone, a thiazolidinedione, with glimepiride, a sulfonylurea. It is approved, along with diet and exercise, to improve blood sugar control in adults with type 2 diabetes who already take a thiazolidinedione and a sulfonylurea, or whose blood sugar is not controlled on one of them alone (section 1). It is not for type 1 diabetes or diabetic ketoacidosis.
Source
DUETACT (pioglitazone and glimepiride) tablets, for oral use, prescribing information and Medication Guide. Takeda Pharmaceuticals America. DailyMed, version published April 9, 2025. DailyMed setid f8b0c917-3fdd-4a28-a47d-6225b8195458
Duetact is taken by mouth once daily with the first main meal (section 2.1).
Each tablet has 30 mg pioglitazone with either 2 mg or 4 mg glimepiride (section 3).
Liver tests (ALT, AST, alkaline phosphatase and total bilirubin) are taken before starting. Routine liver tests during treatment are not recommended in people without liver disease (section 2.1).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Situation | Duetact starting dose |
|---|---|
| Combination tablet considered appropriate | 30 mg/2 mg or 30 mg/4 mg once daily and gradually titrated, as needed |
| Inadequately controlled on glimepiride monotherapy | 30 mg/2 mg or 30 mg/4 mg once daily and gradually titrated, as needed |
| Inadequately controlled on pioglitazone monotherapy | 30 mg/2 mg once daily and gradually titrated, as needed |
| Changing from pioglitazone plus glimepiride as separate tablets | Doses as close as possible to the dose of pioglitazone and glimepiride already being taken |
| On a different sulfonylurea, alone or with pioglitazone | 30 mg/2 mg once daily and adjusted after assessing response. Observe for hypoglycemia for one to two weeks due to the potential overlapping drug effect |
| Systolic dysfunction | The lowest approved dose only after titration from 15 mg to 30 mg of pioglitazone has been safely tolerated |
| Situation | What the label says |
|---|---|
| Maximum recommended daily dose | Pioglitazone 45 mg and glimepiride 8 mg |
| Hypoglycemia with insulin | Decrease the insulin dose by 10% to 25% |
| Hypoglycemia with an insulin secretagogue | Reduce the dose of the insulin secretagogue |
| With gemfibrozil or other strong CYP2C8 inhibitors | Maximum pioglitazone 15 mg daily; switch to the individual components because the minimum dose of pioglitazone in DUETACT exceeds 15 mg |
| With colesevelam | Take DUETACT at least four hours prior to colesevelam |
After starting or a dose increase, people are watched for low blood sugar and for fluid retention, such as weight gain, swelling and heart failure.
In older people, the starting dose, dose increases and maintenance dose are kept conservative to reduce the risk of low blood sugar.
With kidney impairment, the starting dose, dose increases and maintenance dose are also kept conservative, with careful watching for low blood sugar.
During stress such as fever, injury, infection or surgery, medicine needs may change, and patients are told to seek medical advice promptly.
Tablets are stored at 25 C (77 F), with excursions from 15 to 30 C allowed, in a tightly closed container protected from moisture and humidity.
The prescribing information has no missed-dose rule. The Medication Guide says: "If you miss a dose of DUETACT, take your next dose as prescribed unless your doctor tells you differently. Do not take two doses at one time the next day" (printed without a closing period).
More on this: missed a dose of Duetact.
From pioglitazone and glimepiride as separate tablets, Duetact is taken at doses as close as possible to the current ones. From a different sulfonylurea, it starts at 30 mg/2 mg once daily, with watching for low blood sugar for one to two weeks because the effects may overlap.
In Dose Track you set up Duetact as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.