BMA Concise Guide to Medicine & Drugs

Pioglitazone

Brand name Actos

Used in the following combined preparation Competact

QUICK REFERENCE

Drug group Drug for diabetes

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Pioglitazone is an oral antidiabetic drug of the thiazolidinedione type used to treat Type 2 diabetes. It works by reducing insulin resistance in body tissues, which leads to a reduction of blood glucose levels. The effects appear gradually and reach their full extent in about 8 weeks. Pioglitazone may be used alone but is often used with metformin and/or a sulphonylurea; it is available as a combined preparation with metformin. Pioglitazone works better in obese diabetics, although it often causes weight gain. It may also be used with insulin in Type 2 diabetics, although this may increase the risk of heart failure. Bone fractures are another possible adverse effect of pioglitazone.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets.

Frequency and timing of doses 1–2 x daily.

Adult dosage range 4–8mg daily.

Onset of effect 60 minutes; it can take 8 weeks for full effects to appear.

Duration of action 12–24 hours.

Diet advice An individualized diabetic diet must be maintained for the drug to be fully effective. Follow your doctor’s advice.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours, take a single dose now and skip the next.

Stopping the drug Do not stop taking the drug without consulting your doctor; stopping the drug may lead to worsening of the underlying condition.

OVERDOSE ACTION

Seek immediate medical advice in all cases. Take emergency action if loss of consciousness occurs.

POSSIBLE ADVERSE EFFECTS

Fatigue and weakness (due to anaemia) and weight gain (even on a strict diabetic diet) are common side effects, as are indigestion, flatulence, nausea, abdominal pain, and headache. More rarely, the drug may cause dark urine, dizziness, pins and needles, bone pain in the arms, hands, and feet, oedema (water retention), breathlessness, and a cough. Discuss with your doctor if indigestion or flatulence are severe, or if you have any of the other side effects. If jaundice occurs, you should stop taking the drug and contact your doctor immediately. Pioglitazone has also been associated with heart failure, and long-term use carries an increased risk of fractures (see Prolonged use).

INTERACTIONS

Diazoxide, corticosteroids, diuretics, and progesterones may reduce the effects of pioglitazone.

Gemfibrozil reduces the metabolism of pioglitazone, so a reduced dose may be necessary.

Non-steroidal anti-inflammatory drugs may increase the risk of fluid retention.

Rifampicin reduces the blood level of pioglitazone, so an increased dose may be necessary.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have liver problems.

· You are anaemic.

· You have a history of heart failure, angina, heart attack, or stroke.

· You have severe kidney failure. You are taking other medicines.

Pregnancy Safety not established. Discuss with your doctor.

Breast-feeding Safety not established. Discuss with your doctor.

Infants and children Not recommended.

Over 60 No special problems, but the elderly may be more susceptible to side effects.

Driving and hazardous work No known problems.

Alcohol Avoid excessive intake. Alcohol can increase pioglitazone’s effect.

PROLONGED USE

Pioglitazone, like other antidiabetic drugs, is used indefinitely. With long-term use there is an increased risk of bone fractures in the arms, hands, and feet. Prolonged use of the related drug rosiglitazone has increased the risk of heart attacks but it is not known if pioglitazone carries the same risk when used long-term.

Monitoring Initial and periodic blood tests of liver function will be performed. Weight will be measured at intervals. Blood sugar levels should be monitored regularly.