Pioglitazone

Indications & Dose:

Diabetes mellitus, type 2, alone or in combination with sulfonylureas, metformin, or insulin; Werner syridrome; polycystic ovary syndrome

•  BY MOUTH

Adult and Child >18yr

• PO 15-30 mg qd (maximum dose 45 mg/day)

Hepatic Impairment

• Avoid use with concurrent liver dysfunction 

Contraindications:

Diabetes mellitus, type 1 ;diabetic ketoacidosis; hepatic function impairment or clinical evidence of active liver disease (transaminase elevation >2.5 times upper limit of normal), hypersensitivity, uncompensated CHF 

Side Effects:

CNS: Headache, paresthesia
CV: Edema, fluid retention, CHF
EENT: Aggravation of retinopathy, sinusitis, pharyngitis
GI: Abdominal discomfort. hepatotoxicity (incidence, 0.25%)
HEME: Anemia (2-4% drop in hema over 12 weeks)
METAB: Hypoglycemia (with sulfo or insulin)
MS: Myalgia, elevated CK

Cautions:

Precautions:

Congestive heart failure (NYHA 111. IV), anemia, edema, weight gain, premenopausal anovulatory patients with insulin resistance (ovulation may resume and pregnancy may occur if not protected) 

Interaction:

Drugs

• Combination oral contraceptives: May reduce estrogen and progestin levels (another thiazolidinedione reduced both hormones 30%) • Fenugreek, ginseng, glucoman guar gum: Pharmacodynamic interaction as both pioglitazone and listed natural products both possess hypoglycemic effects

Labs

• Possible elevations of AST, ALT bilirubin, LDH; increases in LDL-cholesterol (15%) and HDLcholesterol (15%); decreased in hematocrit, hemoglobin; decreased alkaline phosphatase 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C; abnormally high glucose levels during pregnancy associated with higher incidence of congenital anomalies, morbidity, and mortality; insulin therapy or sulfonylurea preferred agents; breast milk excretion unknown 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: