Pioglitazone
It is a thiazolidinedione antidiabetic agent that depends on the presence of insulin for its mechanism of action. It decreases insulin resistance in the periphery and in the liver resulting in increased insulin-dependent glucose disposal and decreased hepatic glucose output.It is an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes. It is indicated for monotherapy and in combination with a sulfonylurea, metformin, or insulin when diet and exercise plus the single agent does not result in adequate glycemic control.
In patient not adequately controlled with diet and exercise may be initiated at 15mg or 30mg once daily. For patients who respond inadequately to the initial dose of it, the dose can be increased in increments upto 45mg once daily.In combination with a sulfonylurea may be initiated at 15mg or 30mg once daily. In combination with metformin may be initiated at 15mg or 30mg once daily. In combination with insulin may be initiated at 15 mg or 30mg once daily
-Heart Failure: Pioglitazone is contraindicated in patients with severe heart failure (NYHA Class III or IV). -Allergy: Patients with known hypersensitivity to pioglitazone or any of its components should avoid this medication. -Bladder Cancer: It is not recommended for use in patients with active bladder cancer or a history of bladder cancer.
-Heart Failure Risk: Pioglitazone may increase the risk of heart failure, so monitoring for signs and symptoms of heart failure is crucial. -Liver Function: Liver function tests should be monitored periodically, as pioglitazone may cause liver toxicity. -Edema and Weight Gain: The medication may cause fluid retention, leading to edema and weight gain. -Bone Fractures: There is an increased risk of fractures, particularly in women, so bone health should be monitored. -Pregnancy and Breastfeeding: The safety of pioglitazone during pregnancy and breastfeeding is not well established; consult a healthcare provider.
-Common side effects include weight gain, edema, and headache. -Other possible side effects include anemia, upper respiratory tract infection, and back pain. -Serious side effects include liver damage, heart failure, and an increased risk of fractures.
-Other Antidiabetic Drugs: The risk of hypoglycemia may increase when used with other antidiabetic agents. -CYP2C8 Inhibitors/Inducers: Medications that inhibit or induce the CYP2C8 enzyme can affect pioglitazone's blood levels. -Digoxin: Pioglitazone may increase digoxin levels, requiring careful monitoring.
