Formulary
Pioglitazone: Indications, Dosing, Side Effects and Interactions
The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
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Pioglitazone: Indications, Dosing, Side Effects and Interactions
The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
Drug action
The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
Indications and dose
**Type 2 diabetes mellitus as monotherapy (if metformin inappropriate), or in combination with other antidiabetic drugs (including insulin) if existing treatment fails to achieve adequate glycaemic control**
- **Adult** (By Mouth): Initially 15-30 mg once daily, adjusted according to response to 45 mg once daily, review treatment after 3-6 months and regularly thereafter. In elderly patients, initiate with lowest possible dose and increase gradually.
Cautions
Concomitant use with insulin (risk of heart failure); elderly (increased risk of heart failure, fractures, and bladder cancer); increased risk of bone fractures, particularly in women; risk factors for bladder cancer; risk factors for heart failure Cautions, further information Elderly For thiazolidenediones, Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate in patients with heart failure (contra-indicated; risk of exacerbation).
Contraindications
Diabetic ketoacidosis; history of heart failure; previous or active bladder cancer; uninvestigated macroscopic haematuria
Side effects
Common or very common Bone fracture; increased risk of infection; numbness; visual impairment; weight increased Uncommon Bladder cancer; insomnia Frequency not known Macular oedema Side-effects, further information Rare reports of liver dysfunction; discontinue if jaundice occurs.
Interactions
**Other interactions (21):**
- Interaction studies suggest that the pharmacokinetics of empagliflozin were not influenced by co-administration with metformin, glimepiride, pioglitazone, sitagliptin, linagliptin, warfarin,...
- Interaction studies conducted in healthy volunteers suggest that empagliflozin had no clinically relevant effect on the pharmacokinetics of metformin, glimepiride, pioglitazone, sitagliptin,...
- Linagliptin had no clinically relevant effect on the pharmacokinetics of metformin, glibenclamide, simvastatin, pioglitazone, warfarin, digoxin, empagliflozin or oral contraceptives providing in...
- John's wort, pioglitazone) may be used with the recommended dose of raltegravir.
- Combination with pioglitazone, metformin and glyburide Results from studies conducted with these oral antidiabetics have shown no clinically relevant pharmacokinetic interactions.
- CYP1A2 and CYP2C8 substrates Enzalutamide (160 mg once daily) did not cause a clinically relevant change in the AUC or C max of caffeine (CYP1A2 substrate) or pioglitazone (CYP2C8 substrate).
Pregnancy
Avoid-toxicity in animal studies.
Breast feeding
Avoid-present in milk in animal studies.
Hepatic impairment
Manufacturer advises avoid.
Medicinal forms
Suspension
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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