Pioglitazone
Generic Name: Pioglitazone
Brand Names: Actos, Oseni
Ingredients: Pioglitazone
Drug Class: Thiazolidinediones
Controlled Status: Not a Controlled Substance
Availability: Prescription Medication only
What is Pioglitazone?
Pioglitazone belongs to a class of drugs known as thiazolidinediones. Its mechanism of action involves enhancing the body’s sensitivity to insulin, a natural substance responsible for blood sugar level regulation. Pioglitazone is employed in conjunction with a diet and exercise program, and occasionally alongside other medications, to address type 2 diabetes. This condition arises when the body fails to use insulin effectively, leading to an inability to regulate blood sugar levels properly. It’s important to note that Pioglitazone is not intended for the treatment of type 1 diabetes, a condition where the body doesn’t produce insulin, or for diabetic ketoacidosis, a severe condition that can develop if high blood sugar remains untreated.
A comprehensive approach to diabetes management encompasses taking prescribed medication(s), making lifestyle adjustments such as dietary improvements, regular exercise, and quitting smoking, as well as monitoring blood sugar levels regularly.
Such measures can contribute to better diabetes control and overall health enhancement. This therapeutic approach may also reduce the likelihood of heart attacks, strokes, and other diabetes-related complications like kidney failure, nerve damage (manifested as numbness or coldness in the legs or feet and reduced sexual function in both men and women), eye issues, including vision changes or loss, and gum disease. Your healthcare team, including your doctor, will guide you on the most suitable method for managing your diabetes effectively.
What is Pioglitazone Used for?
Pioglitazone, classified as a thiazolidinedione-type diabetes medication, is utilized in conjunction with a balanced diet and exercise regimen to regulate elevated blood sugar levels in patients with type 2 diabetes. Its mode of action involves aiding in the restoration of your body’s proper response to insulin, consequently lowering your blood sugar levels. Effective management of high blood sugar can help prevent complications such as kidney damage, vision impairment, nerve issues, limb loss, and sexual function difficulties. Moreover, controlling diabetes appropriately can reduce the risk of heart attacks or strokes.
Pioglitazone may be prescribed either as a standalone treatment or in combination with other diabetes medications, such as metformin or a sulfonylurea like glyburide. It’s essential to have a discussion with your doctor regarding the potential benefits and risks associated with pioglitazone.
Your doctor may initiate your treatment with a low dose of pioglitazone and gradually raise it.
While pioglitazone effectively manages type 2 diabetes, it’s important to note that it is not a cure for the condition. It may take up to two weeks for your blood sugar levels to decrease and two to three months to experience the full benefits of pioglitazone. It is crucial to continue taking pioglitazone as directed even if you are feeling well and not discontinue the medication without consulting your doctor.
How does Pioglitazone Work?
Pioglitazone acts as a specific stimulant for the peroxisome proliferator-activated receptor-gamma (PPARγ) in target tissues responsible for insulin function, such as adipose tissue, skeletal muscle, and the liver. This activation of PPARγ promotes the transcription of genes that respond to insulin, ultimately regulating the production, transportation, and utilization of glucose and lipids. Through this process, pioglitazone enhances the sensitivity of tissues to insulin and decreases the liver’s glucose production (known as gluconeogenesis). This, in turn, leads to an improvement in insulin resistance associated with type 2 diabetes mellitus, all without necessitating an increase in insulin secretion by pancreatic beta cells.
Pioglitazone Dosage
The recommended dosage of this medication for adults with Type 2 diabetes varies depending on whether the patient has congestive heart failure. For patients without congestive heart failure, the initial dose is either 15 mg or 30 mg, taken orally once a day. Conversely, for patients with congestive heart failure classified as New York Heart Association (NYHA) Class I or II, the initial dose is 15 mg, also taken orally once a day. The maintenance dose ranges from 15 mg to 45 mg, administered orally once a day, and this range is determined based on the patient’s glycemic response as assessed by HbA1c levels. The maximum recommended dose is 45 mg, taken orally once daily.
It’s important to note that this medication’s antihyperglycemic effect is dependent on the presence of endogenous insulin. Therefore, it is not anticipated to be effective in patients with type 1 diabetes mellitus or diabetic ketoacidosis. In cases where patients are concurrently using an insulin secretagogue or insulin, they may need to consider reducing the dose of the insulin secretagogue or insulin if hypoglycemia occurs during treatment.
The medication is available in tablet form for oral administration and is typically taken once daily, with or without meals, at approximately the same time each day. The primary purpose of this medication is to serve as an adjunct to dietary and exercise measures, with the aim of enhancing glycemic control in adults diagnosed with Type 2 diabetes mellitus in various clinical settings. The dosing recommendations mentioned are general guidelines, and individualized dosages may be necessary based on specific patient factors and the guidance of healthcare professionals. Always consult with a healthcare provider for personalized dosing instructions.
What are the Side Effects of Pioglitazone?
If you experience signs of an allergic reaction, such as hives, difficulty breathing, or swelling of your face, lips, tongue, or throat, seek immediate medical assistance. Discontinue the use of pioglitazone and promptly contact your doctor if you notice symptoms indicative of liver damage, including nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, or jaundice (yellowing of the skin or eyes).
It’s important to be aware that pioglitazone may lead to severe side effects. Get in touch with your doctor without delay if you encounter any of the following: shortness of breath, especially when lying down, unusual tiredness, swelling, or rapid weight gain; pink or red urine, painful or difficult urination, or a new or worsening urge to urinate; changes in your vision; or sudden unusual pain in your hand, arm, or foot.
While some individuals taking pioglitazone have developed bladder cancer, it remains unclear whether pioglitazone was the direct cause of this outcome. The common side effects of pioglitazone encompass symptoms like headaches, muscle pain, or cold-related symptoms such as a stuffy nose, sinus discomfort, sneezing, or a sore throat. It’s important to note that this list is not exhaustive, and other side effects may occur.
For more details about Side effect of Pioglitazone
Contact your healthcare provider for guidance regarding any potential side effects. You can also report side effects to the U.S. Food and Drug Administration (FDA) by calling 1-800-FDA-1088.
How to Use Pioglitazone?
To use this medication, swallow it with a glass of water. Adhere to the instructions provided on your prescription label, and make it a habit to take your medication at the same time every day. Avoid taking it more frequently than prescribed.
When you receive your prescription or refill, the pharmacist will provide you with a specialized MedGuide. It’s essential to diligently read this information every time. If this medication is intended for use in children, it’s advisable to discuss it with your healthcare team, as special precautions may be necessary. In the event that you suspect an overdose, contact a poison control center or the nearest emergency room immediately.
Please remember that this medication is prescribed for you alone. Do not share it with others.
What Happens if I Miss a Dose of Pioglitazone?
Please take your medication as soon as possible, but if your next scheduled dose is approaching, it’s advisable to skip the missed dose. Avoid taking two doses simultaneously.
What Happens if I Overdose Pioglitazone?
Signs and Symptoms of overdose include: You might encounter symptoms of low blood sugar, which can manifest as pronounced weakness, blurred vision, excessive sweating, speech difficulties, tremors, abdominal discomfort, confusion, and even seizures (convulsions). If you experience these symptoms, it’s important to seek medical attention promptly.
In case of a medical emergency, please seek immediate medical assistance or contact the Poison Help Line at 1-800-222-1222. Information is also available online at poisonhelp.org. Nevertheless, if you are experiencing severe symptoms, please do not hesitate to dial 911 (or your Local Emergency Number) immediately or proceed to the nearest emergency room for immediate medical attention. Your safety and well-being are paramount.
Pros and Cons of Pioglitazone
| Pros | Cons |
| -Reduces A1c levels by approximately 1% | Not the first-choice medication for type 2 diabetes |
| Only once-daily dosing | May take several weeks to lower blood sugar |
| May increase “good” cholesterol and reduce triglycerides | Can lead to weight gain |
| Guards against harmful effects of high sugar levels | Risk of fluid retention, from ankle swelling to lung fluid accumulation |
| Rarely causes dangerously low blood sugar on its own | Elevated risk of bone fractures, especially for females or those at risk |
| Lowers the risk of heart attack or stroke | Not suitable for individuals with bladder cancer |
| No need to take with food | Not recommended for those with uncontrolled heart failure and not for individuals with diabetic ketoacidosis |
| Lower risk of causing stroke or heart failure compared to Avandia (rosiglitazone) | Inappropriate for people with type 1 diabetes and special precautions needed for sexually active premenopausal women regarding pregnancy |
Interaction between Pioglitazone and other Drugs
- Atorvastatin
- Birth control pills or other hormonal methods of birth control
- Bosentan
- Itraconazole
- Ketoconazole
- Midazolam
- Nifedipine
- Other medications for diabetes, including insulin
- Topiramate
Pioglitazone and Alcohol Warning
Alcohol has the potential to lower blood sugar levels, causing hypoglycemia, and this risk may become more pronounced when you are using Actos. Therefore, if your blood glucose levels are not adequately controlled, your doctor may recommend complete abstinence from alcohol. However, if your blood glucose levels are well-managed, they might provide guidance on a safe amount of alcohol that you can consume. It’s essential to follow your healthcare provider’s advice in this regard to ensure your health and safety.
Pioglitazone and Birth Control Needs
The safety of using Actos (Pioglitazone) during pregnancy is not well-established, and there are uncertainties regarding its effects on pregnant women. It’s important to be aware that women with irregular menstrual cycles who are taking Actos (Pioglitazone) may experience ovulation, which is the release of an egg during the menstrual cycle. This ovulation could potentially lead to pregnancy. If you are sexually active, and either you or your partner has the potential to conceive, it is advisable to have a discussion with your doctor about your contraceptive needs while you are using Actos. This precaution can help ensure that appropriate birth control measures are in place.
Warning with People with Certain Health Conditions
- Alcohol containing beverages
- Aspirin and aspirin-like medications
- Chloramphenicol
- Chromium
- Diuretics
- Female hormones, like estrogens or progestins and birth control pills
- Heart medications
- Isoniazid
- Male hormones or anabolic steroids
- Medications for weight loss
- Medications for allergies, asthma, cold, or cough
- Medications for mental problems
- Medications called MAO Inhibitors like Nardil, Parnate, Marplan, Eldepryl
- Niacin
- NSAIDs, medications for pain and inflammation, like ibuprofen or naproxen
- Pentamidine
- Phenytoin
- Probenecid
- Quinolone antibiotics like ciprofloxacin, levofloxacin, ofloxacin
- Some herbal dietary supplements
- Steroid medications like prednisone or cortisone
- Thyroid medication
Warning with other Groups
Pioglitazone and Pregnancy
Limited data on the use of pioglitazone in pregnant women do not provide enough information to determine the extent of any drug-related risk for significant birth defects or miscarriages. However, it’s crucial to recognize that there are inherent risks to both the mother and the fetus when diabetes is inadequately controlled during pregnancy. In such cases, the maternal risks include diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, stillbirth, and complications during delivery. Fetal risks encompass major birth defects, stillbirth, and complications related to excessive fetal growth (macrosomia).
Pioglitazone and Breastfeeding
As for breastfeeding, there is no available information about the presence of pioglitazone in human milk, its effects on the breastfed infant, or its impact on milk production. When considering whether to breastfeed, it’s essential to weigh the developmental and health benefits of breastfeeding against the mother’s clinical need for pioglitazone and any potential adverse effects on the breastfed infant arising from pioglitazone itself or the underlying maternal medical condition. This decision should be made in consultation with a healthcare provider.
Expiration, Storage and Disposal
When you get Actos (Pioglitazone) from the pharmacy, the pharmacist will put an expiration date on the bottle label. Usually, this date is one year from the date the medication was dispensed.
The reason for this expiration date is to make sure the medication remains effective during that time. If you have any of the medication left after it has expired, it’s a good idea to check with your pharmacist to see if it’s still safe to use.
Disposal of Unused Medication:
Any unused or expired medication should be disposed of in a manner that prevents accidental consumption by pets, children, or others. Do not flush the medication down the toilet.
- Safe Medication Disposal: The recommended method for disposing of this medication is through a medicine take-back program. You can consult with your pharmacist or get in touch with your local garbage/recycling department to inquire about available take-back programs in your community. For more information on safe medication disposal, you can also visit the FDA’s Safe Disposal of Medicines website at http://goo.gl/c4Rm4p.
- Child Safety: To safeguard young children from accidental ingestion, especially since some containers may not be child-resistant, always ensure that safety caps are locked, and store the medication in a secure location that is both out of sight and out of reach.
Remember, the goal is to prevent unintentional access to medications, especially by children, to ensure their safety and well-being. Visit http://www.upandaway.org for additional information on this matter.
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What are the Alternatives of Pioglitazone?
- Exenatide (Byetta, Bydureon)
- Semaglutide (Ozempic)
- Insulin (Humalog, Humulin R, Humulin N, Novolog, Novolin, Lantus, Others)
- Liraglutide (Victoza)
- Dulaglutide (Trulicity)
- Metformin (Glucophage)
- Glyburide (Diabeta)
- Glipizide (Glucotrol)
- Glimepiride (Amaryl)
- Sitagliptin (Januvia)
- Linagliptin (Tradjenta)
- Saxagliptin (Onglyza)
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
- Canagliflozin (Invokana)
- Rosiglitazone (Avandia)
FAQs
Pioglitazone is recognized as a potential treatment for non-alcoholic fatty liver disease (NAFLD). It’s important to note that the effects of pioglitazone on NAFLD can vary between diabetic and non-diabetic patients, and different outcomes have been observed in these two groups.
Pioglitazone is effective in enhancing insulin sensitivity in individuals with diabetes, but it is frequently associated with weight gain.
There is a potential increased risk of bladder cancer associated with the use of pioglitazone, and this risk may be influenced by both the dosage and the duration of exposure. Therefore, patients who have been exposed to pioglitazone for an extended period at higher doses should undergo regular monitoring for signs and symptoms of bladder cancer.
Contraindications for the use of pioglitazone include individuals with a known hypersensitivity to pioglitazone or any of its components, as it may lead to adverse reactions. Additionally, it is not suitable for those with diabetic ketoacidosis or type 1 diabetes, given that pioglitazone’s effectiveness relies on the presence of insulin. Furthermore, individuals experiencing hypoglycemia should exercise caution, and regular blood sugar monitoring is imperative to ensure safe and effective use of the medication.
Yes, metformin and pioglitazone can be taken together. They are a combination of two oral diabetes medications that work in conjunction to help regulate blood sugar levels. This combination is typically used alongside dietary adjustments and physical exercise to enhance blood sugar control in adults diagnosed with type 2 diabetes mellitus who do not rely on daily insulin injections for their treatment.
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