Class: Thiazolidinedione Antidiabetic
Dosage Forms. Tablet: 15 mg, 30 mg, 45 mg
Common FDA Label Indication, Dosing, and Titration.
1. Diabetes mellitus, Type II: 15-30 mg po daily; may titrate to max of 45 mg po daily as monotherapy, or in combination with sulfonylurea, metformin, or insulin
1. Polycystic ovary syndrome: 45 mg po daily
MOA. Pioglitazone is a thiazolidinedione antihyperglycemic and a potent peroxisome proliferator-activated receptor-gamma (PPAR [gamma]) agonist used to improve insulin sensitivity in patients with Type II diabetes. Insulin-dependent glucose disposal in skeletal muscle is improved and hepatic glucose production is decreased; both actions contribute to pioglitazone’s glucose-lowering effects.
Drug Characteristics: Pioglitazone
Medication Safety Issues: Pioglitazone
Drug Interactions: Pioglitazone
Adverse Reactions: Pioglitazone
Efficacy Monitoring Parameters. Preprandial blood glucose between 70 and 130 mg/dL, HbA1c <7%.
Toxicity Monitoring Parameters. Weight for assessment of edema, Hgb, LFTs; symptoms of hypoglycemia include, nausea, sweating, and loss of consciousness; seek care for bone pain, yellowing of skin or eyes, eye pain, or shortness of breath; eye exams.
Key Patient Counseling Points. Monitor blood glucose in frequent intervals (2-4 times per day). May take without regard to food. May require several weeks for max effect.
Clinical Pearls. Pioglitazone causes edema, which may exacerbate underlying CHF; use with caution. Pioglitazone is being investigated as an anticancer agent. Premenopausal anovulatory individuals may resume ovulation. Not for use in children. Stimulates ovulation. Increased risk of pregnancy in premenopausal female diabetics. Use effective birth control. Medication guide required at dispensing.