Pioglitazone

Chemical formula: C₁₉H₂₀N₂O₃S Molecular mass: 356.439 g/mol PubChem compound: 4829

Therapeutic indications

Pioglitazone is indicated for:

Diabetes mellitus type 2

Population group: only adults (18 years old or older)

Pioglitazone is indicated as second or third line treatment of type 2 diabetes mellitus as described below:

as monotherapy:

in adult patients (particularly overweight patients) inadequately controlled by diet and exercise for whom metformin is inappropriate because of contraindications or intolerance

as dual oral therapy in combination with:

metformin, in adult patients (particularly overweight patients) with insufficient glycaemic control despite maximal tolerated dose of monotherapy with metformin
a sulphonylurea, only in adult patients who show intolerance to metformin or for whom metformin is contraindicated, with insufficient glycaemic control despite maximal tolerated dose of monotherapy with a sulphonylurea.

as triple oral therapy in combination with:

metformin and a sulphonylurea, in adult patients (particularly overweight patients) with insufficient glycaemic control despite dual oral therapy.

Pioglitazone is also indicated for combination with insulin in type 2 diabetes mellitus adult patients with insufficient glycaemic control on insulin for whom metformin is inappropriate because of contraindications or intolerance.

After initiation of therapy with pioglitazone, patients should be reviewed after 3 to 6 months to assess adequacy of response to treatment (e.g. reduction in HbA1c). In patients who fail to show an adequate response, pioglitazone should be discontinued. In light of potential risks with prolonged therapy, prescribers should confirm at subsequent routine reviews that the benefit of pioglitazone is maintained.

For this indication, competent medicine agencies globally authorize below treatments (click for details):

15-45 mg once daily

Contraindications

Pioglitazone is contraindicated in the following cases:

Cardiac failure, history of cardiac failure

Cardiac failure

Hepatic impairment

Hepatic insufficiency

Diabetic ketoacidosis

Current bladder cancer, history of bladder cancer

at least one of

Malignant tumour of urinary bladder
History of bladder neoplasm

Uninvestigated macroscopic haematuria

Frank hematuria

Dialysed patients

at least one of

Renal failure stage 5: Kidney failure (GFR <15 mL/min/1.73 m2 or dialysis)
Renal dialysis

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