Drug Action
The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
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Individual generic drug information
Extracted information for Pioglitazone only.
The thiazolidinedione, pioglitazone, reduces peripheral insulin resistance, leading to a reduction of blood-glucose concentration.
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Type 2 diabetes mellitus (alone or combined with metformin or a sulfonylurea, or with both, or with insulin) ▶BY MOUTH ▶Adult: Initially 15–30 mg once daily, adjusted according to response to 45 mg once daily, in elderly patients, initiate with lowest possible dose and increase gradually; review treatment after 3–6 months continued → and regularly thereafter
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DUE TO INTERACTIONS ▶Dose of concomitant sulfonylurea or insulin may need to be reduced.
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History of heart failure. previous or active bladder cancer. uninvestigated macroscopic haematuria
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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, prescription potentially inappropriate (STOPP criteria) in patients with heart failure (risk of exacerbation). See also Prescribing in the elderly p. 33.
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Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (March 2007) that the use of pioglitazone with metformin and a sulfonylurea, is accepted for restricted use within NHS Scotland for patients (especially if overweight) whose glycaemic control is inadequate despite the use of 2 oral hypoglycaemic drugs and who are unable or unwilling to take insulin; treatment should be initiated and monitored by an experienced diabetes physician.
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Extracted information for Pioglitazone only.
MHRA/CHM ADVICE: PIOGLITAZONE CARDIOVASCULAR SAFETY (DECEMBER 2007 AND JANUARY 2011) Incidence of heart failure is increased when pioglitazone is combined with insulin especially in patients with Endocrine system predisposing factors e.g. previous myocardial infarction. Patients who take pioglitazone should be closely monitored for signs of heart failure; treatment should be discontinued if any deterioration in cardiac status occurs. Pioglitazone should not be used in patients with heart failure or a history of heart failure. PIOGLITAZONE: RISK OF BLADDER CANCER (JULY 2011) The European Medicines Agency has advised that there is a small increased risk of bladder cancer associated with pioglitazone use. However, in patients who respond adequately to treatment, the benefits of pioglitazone continue to outweigh the risks. Pioglitazone should not be used in patients with active bladder cancer or a past history of bladder cancer, or in those who have uninvestigated macroscopic haematuria. Pioglitazone should be used with caution in elderly patients as the risk of bladder cancer increases with age. Before initiating treatment with pioglitazone, patients should be assessed for risk factors of bladder cancer (including age, smoking status, exposure to certain occupational or chemotherapy agents, or previous radiation therapy to the pelvic region) and any macroscopic haematuria should be investigated. The safety and efficacy of pioglitazone should be reviewed after 3–6 months and pioglitazone should be stopped in patients who do not respond adequately to treatment. Patients already receiving treatment with pioglitazone should be assessed for risk factors of bladder cancer and treatment should be reviewed after 3–6 months, as above. Patients should be advised to report promptly any haematuria, dysuria, or urinary urgency during treatment.
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→Appendix 1: pioglitazone
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▶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.
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Avoid—toxicity in animal studies.
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Avoid—present in milk in animal studies.
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Manufacturer advises avoid.
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Monitor liver function before treatment and periodically thereafter.
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Extracted information for Pioglitazone only.
There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension Tablet ▶Pioglitazone (Non-proprietary) Pioglitazone (as Pioglitazone hydrochloride) 15 mg Pioglitazone 15mg tablets | 28 tablet P £26.00 DT = £1.41 Pioglitazone (as Pioglitazone hydrochloride) 30 mg Pioglitazone 30mg tablets | 28 tablet P £36.00 DT = £1.55 Pioglitazone (as Pioglitazone hydrochloride) 45 mg Pioglitazone 45mg tablets | 28 tablet P £40.00 DT = £1.82 ▶Actos (Takeda UK Ltd) Pioglitazone (as Pioglitazone hydrochloride) 15 mg Actos 15mg tablets | 28 tablet P £25.83 DT = £1.41 Pioglitazone (as Pioglitazone hydrochloride) 30 mg Actos 30mg tablets | 28 tablet P £35.89 DT = £1.55 Pioglitazone (as Pioglitazone hydrochloride) 45 mg Actos 45mg tablets | 28 tablet P £39.55 DT = £1.82 ▶Glidipion (Actavis UK Ltd) Pioglitazone (as Pioglitazone hydrochloride) 15 mg Glidipion 15mg tablets | 28 tablet P £25.83 DT = £1.41 Pioglitazone (as Pioglitazone hydrochloride) 30 mg Glidipion 30mg tablets | 28 tablet P £35.89 DT = £1.55 Pioglitazone (as Pioglitazone hydrochloride) 45 mg Glidipion 45mg tablets | 28 tablet P £39.55 DT = £1.82
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Extracted information for Pioglitazone only.
Liver toxicity Patients should be advised to seek immediate medical attention if symptoms such as nausea, vomiting, abdominal pain, fatigue and dark urine develop.
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Filter the extracted dose blocks for this individual drug.
First line only; read the complete Indications and dose section above.
Initially 15–30 mg once daily, adjusted
This is a first-line fragment. Read the full Indications and Dose section above.
Candidate age grouping · source page 771