Pioglitazone

Pioglitazone Brand Name– Actos

What is Pioglitazone

Pioglitazone is an oral antidiabetic agent of the thiazolidinedione (TZD) class, also called ‘insulin sensitizers.’ Pioglitazone is approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 DM (DM) and is given once daily.

The TZDs specifically target insulin resistance that is central to the development of Type 2 DM as well as dyslipidemia and hypertension in patients with DM.

Pioglitazone therapy results in improvements in glycemic control as indicated by significant reductions in fasting plasma glucose (FPG) and hemoglobin A1C.

Pioglitazone has been shown to reduce some cardiovascular endpoints, but without conclusive evidence of benefit.

The TZDs, including pioglitazone, cause or exacerbate congestive heart failure in some patients and are contraindicated in those with established NYHA Class III or IV heart failure (HF).

Indications

• type 2 diabetes mellitus

For the treatment of type 2 diabetes mellitus

as monotherapy or in combination with metformin or a sulfonylurea as an adjunct to diet and exercise to improve glycemic control

Side Effects

1. abdominal pain
2. anemia
3. anorexia
4. back pain
5. blurred vision
6. bone fractures
7. chest pain (unspecified)
8. diarrhea
9. dizziness
10. dyspnea
11. edema
12. elevated hepatic enzymes
13. flatulence
14. fluid retention
15. headache
16. heart failure
17. hepatic encephalopathy
18. hepatic failure
19. hyperbilirubinemia
20. hypertension
21. hypoglycemia
22. infection
23. macular edema
24. menstrual irregularity
25. myalgia
26. nausea
27. new primary malignancy
28. osteopenia
29. peripheral edema
30. pharyngitis
31. rhabdomyolysis
32. sinusitis
33. visual impairment
34. vomiting
35. weight gain

Monitoring Parameters

• blood glucose
• glycosylated hemoglobin A1c (HbA1c)
• LFTs
• serum bilirubin
• weight

Contraindications

• acute heart failure
• bladder cancer
• bone fractures
• breast-feeding
• cardiac disease
• children
• contraception requirements
• diabetic ketoacidosis
• edema
• geriatric
• heart failure
• hepatic disease
• hepatotoxicity
• hypoglycemia
• menstrual irregularity
• new primary malignancy
• osteoporosis
• peripheral edema
• polycystic ovary syndrome
• pregnancy
• pulmonary edema

Pioglitazone is contraindicated in patients with a known hypersensitivity to this product or any of its components.

Interactions

• Abiraterone
• Acebutolol
• Acetaminophen; Propoxyphene
• Acetazolamide
• Aliskiren; Valsartan
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amprenavir
• Androgens
• Angiotensin II receptor antagonists
• Angiotensin-converting enzyme inhibitors
• Aripiprazole
• Asenapine
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol
• Atenolol; Chlorthalidone
• Atorvastatin
• Atorvastatin; Ezetimibe
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Azelastine; Fluticasone
• Azilsartan
• Azilsartan; Chlorthalidone
• Beclomethasone
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Benazepril
• Benazepril; Hydrochlorothiazide, HCTZ
• Bendroflumethiazide; Nadolol
• Beta-blockers
• Betamethasone
• Betaxolol
• Bexarotene
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bortezomib
• Brexpiprazole
• Brimonidine; Timolol
• Budesonide
• Budesonide; Formoterol
• Bumetanide
• Candesartan
• Candesartan; Hydrochlorothiazide, HCTZ
• Cannabidiol
• Captopril
• Captopril; Hydrochlorothiazide, HCTZ
• Cariprazine
• Carteolol
• Carvedilol
• Chloroquine
• Chlorthalidone; Clonidine
• Chromium
• Ciclesonide
• Clarithromycin
• Clonidine
• Clopidogrel
• Clozapine
• Cobimetinib
• Conjugated Estrogens
• Conjugated Estrogens; Bazedoxifene
• Conjugated Estrogens; Medroxyprogesterone
• Corticosteroids
• Cortisone
• Cyclosporine
• Dabrafenib
• Daclatasvir
• Danazol
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Deflazacort
• Dexamethasone
• Diazoxide
• Dienogest; Estradiol valerate
• Diethylstilbestrol, DES
• Digoxin
• Disopyramide
• Dorzolamide; Timolol
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Elagolix; Estradiol; Norethindrone acetate
• Elbasvir; Grazoprevir
• Enalapril, Enalaprilat
• Enalapril; Felodipine
• Enalapril; Hydrochlorothiazide, HCTZ
• Eprosartan
• Eprosartan; Hydrochlorothiazide, HCTZ
• Erythromycin; Sulfisoxazole
• Esmolol
• Esterified Estrogens
• Esterified Estrogens; Methyltestosterone
• Estradiol
• Estradiol Cypionate; Medroxyprogesterone
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Estradiol; Progesterone
• Estramustine
• Estrogens
• Estropipate
• Ethacrynic Acid
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethotoin
• Fenofibrate
• Fenofibric Acid
• Fexofenadine
• Fexofenadine; Pseudoephedrine
• Fludrocortisone
• Flunisolide
• Fluoxetine
• Fluoxetine; Olanzapine
• Fluoxymesterone
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Formoterol; Mometasone
• Fosamprenavir
• Fosinopril
• Fosinopril; Hydrochlorothiazide, HCTZ
• Fosphenytoin
• Furosemide
• Garlic, Allium sativum
• Gemfibrozil
• Glecaprevir; Pibrentasvir
• Green Tea
• Hydantoins
• Hydrochlorothiazide, HCTZ; Irbesartan
• Hydrochlorothiazide, HCTZ; Lisinopril
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocortisone
• Hydroxychloroquine
• Iloperidone
• Indapamide
• Indinavir
• Insulins
• Irbesartan
• Isocarboxazid
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Itraconazole
• Ketoconazole
• Labetalol
• Lanreotide
• Ledipasvir; Sofosbuvir
• Leflunomide
• Letermovir
• Levobetaxolol
• Levobunolol
• Linezolid
• Lisinopril
• Lithium
• Lomefloxacin
• Lopinavir; Ritonavir
• Lorcaserin
• Losartan
• Lovastatin; Niacin
• Lumateperone
• Lurasidone
• Mecasermin rinfabate
• Mecasermin, Recombinant, rh-IGF-1
• Mestranol; Norethindrone
• Methazolamide
• Methylprednisolone
• Methyltestosterone
• Metoprolol
• Metyrapone
• Midazolam
• Moexipril
• Mometasone
• Monoamine oxidase inhibitors
• Nadolol
• Nandrolone Decanoate
• Nebivolol
• Nebivolol; Valsartan
• Nelfinavir
• Niacin, Niacinamide
• Niacin; Simvastatin
• Nicotine
• Nifedipine
• Octreotide
• Olanzapine
• Olmesartan
• Ombitasvir; Paritaprevir; Ritonavir
• Orlistat
• Oxandrolone
• Oxymetholone
• Paliperidone
• Pasireotide
• Pegvisomant
• Penbutolol
• Pentamidine
• Pentoxifylline
• Perindopril
• Perindopril; Amlodipine
• Phenelzine
• Phenobarbital
• Phenothiazines
• Phentermine; Topiramate
• Phenytoin
• Pindolol
• Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
• Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
• Prednisolone
• Prednisone
• Pregabalin
• Propoxyphene
• Propranolol
• Protease inhibitors
• Pyrimethamine; Sulfadoxine
• Quetiapine
• Quinapril
• Quinolones
• Ramipril
• Ranitidine
• Reserpine
• Rifampin
• Risperidone
• Ritonavir
• Sacubitril; Valsartan
• Salicylates
• Saquinavir
• Segesterone Acetate; Ethinyl Estradiol
• Selegiline
• Sofosbuvir
• Sofosbuvir; Velpatasvir
• Sofosbuvir; Velpatasvir; Voxilaprevir
• Somatropin, rh-GH
• Sotalol
• Sparfloxacin
• Sulfadiazine
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Sulfasalazine
• Sulfisoxazole
• Sulfonamides
• Sympathomimetics
• Tacrolimus
• Tegaserod
• Telmisartan
• Teriflunomide
• Testolactone
• Testosterone
• Thiazide diuretics
• Thyroid hormones
• Timolol
• Tipranavir
• tobacco
• Topiramate
• Torsemide
• Trandolapril
• Trandolapril; Verapamil
• Tranylcypromine
• Triamcinolone
• Triamterene
• Trimethoprim
• Valsartan
• Zafirlukast
• Ziprasidone

Metformin is first-line in the treatment of type 2 DM. In patients with established cardiovascular (CV) disease, HF, or chronic kidney disease (CKD), a sodium-glucose co-transporter 2 (SGLT2) inhibitor or glucagon-like peptide-1 receptor agonist (GLP-1 RA) with proven CV benefit and reduction of CKD progression is recommended for add-on therapy, independent of baseline A1C or individualized A1C target.^{50321649336492660608} In patients without indicators of high-risk or established CVD, HF, or CKD, pioglitazone and other TZDs are associated with glycemic durability; however, the benefits must be balanced with the risk of adverse effects such as heart failure, edema, decreased bone mineral density, and weight gain.^{2806364926 28109} In patients who are starting insulin therapy and are taking pioglitazone, discontinue or reduce the dose of pioglitazone. Hypoglycemia, fluid retention, and edema are most common when pioglitazone is used in combination with insulin. Pioglitazone may be used cautiously with insulin as long as the insulin dose is carefully titrated to glycemic response.28109 Although not FDA-approved for this purpose, TZDs prevent future development of diabetes in 60% to 75% of subjects with prediabetes.