Pioglitazone is a insulin receptor resensitizer group of drug, used in the management of diabetes mellitus type 2. In this type of diabetes, insulin is produced by the pancreas but is not able to act on the cells of the liver, muscles and other tissues to make them take in the sugar and other food ingredients into the cells for its activities. It may be used alone or with another type of oral diabetic drugs that include sulfonylurea, insulin, or even Metformin (since they act on different enzyme systems.).
Pioglitazone acts primarily on the skeletal muscles in the liver, and to a lesser extent in the liver and other tissues, to increase the activity of insulin, thereby enhancing penetration of glucose into the cells, increasing storage or burning of glucose, and preventing formation of new glucose from stored products (glycogen) or other food substances like proteins and fats.
These drugs do not help patients who are not producing any insulin, unless insulin is given as a supplement injection. This type is called insulin-dependent or type 1 diabetes. Their blood glucose is best controlled by insulin injections.
The dose of pioglitazone has to be individualized for each patient.
- For type 2 diabetes:
- Pioglitazone alone, or along with insulin, Metformin or a sulfonylurea
- Adults: Initially, 15 or 30 mg once daily with or without meals, up to a maximum dose of 45 mg once daily.
- Children: Use and dose must be determined by your doctor.
Missed dose: If you miss a dose of this medicine, take it as soon as you remember. However, if you do not remember it until it is time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Pioglitazone may be taken with or without food .
Before Using This Medicine
Your doctor needs to know some information about you before you are prescribed this drug. Tell him about the following:
- Allergies–Any unusual or allergic reaction to pioglitazone ? Also tell your doctor if you are allergic to any other substances, such as foods, preservatives, or dyes.
- Pregnancy–No oral antidiabetic drug is recommended during pregnancy. If you are pregnant or contemplating pregnancy, you need to be on insulin for the duration of pregnancy, in the best interests of your baby. This is in spite of the fact that so far, pioglitazone seems to be safe during pregnancy.
- Breast-feeding–The safety of pioglitazone has not been assessed in lactating women. Hence it is better avoided if you contemplate breast feeding your child.
- Children–Due to ethical reasons, studies on this medicine have been done only in adult patients, and there is no scientific information comparing use of metformin in children with use in other age groups.
- Older adults–The drug has been used in a limited scale in older (above 65 years age) patients, and appears to be as safe and useful as in younger adults.
- Other medicines–Pioglitazone interacts with many drugs and chemicals, whose simultaneous use must be done with caution if at all:
Ketoconazole–Use of this medicine with pioglitazone may decrease the effect of pioglitazone
Miscellaneous –The following conditions make it risky to use pioglitazone:
- Diabetic ketoacidosis (ketones in the blood)
- Type 1 diabetes-Insulin is needed to control these conditions
- Heart disease
- Liver disease-Pioglitazone may make these conditions worse
Many of these conditions lead to rapid blood sugar level changes : a condition best managed by Insulin Injections, till the crisis period is over.
Precautions While Using This Medicine
- Liver disorder Drugs of the class of pioglitazone have the potential to damage the liver in rare patients. Keep a watch out for stomach pain, dark urine, loss of appetite, nausea or vomiting, unusual tiredness or weakness, or yellow eyes or skin. Visit your doctor at regular intervals to ensure you do not have any adverse effect from taking this drug.
- Alcohol Drinking alcohol may cause severe low blood sugar.
- Other medicines Many medicines show drug interaction with pioglitazone. These include medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
- Counseling–Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, diabetic patients may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy.
- Travel–Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.
- In case of emergency –There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
- This medicine does not cause hypoglycemia (low blood sugar). However, low blood sugar can occur if you delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting.
- Symptoms of low blood sugar include anxiety; behavior change similar to being drunk; blurred vision; cold sweats; confusion; cool, pale skin; difficulty in thinking; drowsiness; excessive hunger; fast heartbeat; headache (continuing); nausea; nervousness; nightmares; restless sleep; shakiness; slurred speech; or unusual tiredness or weakness.
- If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes; or drink fruit juice, non-diet soft drink, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar. Glucagon is used in emergency situations when severe symptoms such as seizures (convulsions) or unconsciousness occur Have a glucagon kit available, along with a syringe and needle, and know how to use it. Members of your family also should know how to use it.
High blood sugar may occur if you do not take enough or skip a dose of your antidiabetic medicine, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual. Symptoms of high blood sugar include blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination should include the (frequency and amount); ketones in urine; loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); unconsciousness; or unusual thirst.
Side Effects of This Medicine
|Rare||Swelling of feet or lower legs|
|More common||Problems with teeth Cough; fever; headache; muscle soreness; runny or stuffy nose; sore throat|