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Author: Admin | 2025-04-28
Brand names: Actos, ActoPlus Met (combination), ActoPlus Met XR (combination), Duetact (combination)Drug class: ThiazolidinedionesATC class: A10BG03VA class: HS502Chemical name: (±)-5-[p-[2-(5-Ethyl-2-pyridyl)ethoxy]benzyl]-2,4-thiazolidinedione monohydrochlorideMolecular formula: C19H20N2O3S•ClHCAS number: 112529-15-4 IntroductionUsesDosageWarningsInteractionsStability WarningHeart FailureThiazolidinediones, including pioglitazone, cause or exacerbate heart failure in some patients. Monitor for signs and symptoms of heart failure (e.g., dyspnea, rapid and excessive weight gain, edema) after initiation of therapy and dosage titration. If heart failure develops, manage according to current standards of care; consider discontinuance or reduction in dosage of pioglitazone. Not recommended in patients with symptomatic heart failure. Initiation of pioglitazone contraindicated in patients with NYHA class III or IV heart failure. (See Heart Failure under Cautions.)IntroductionAntidiabetic agent; thiazolidinedione (glitazone). Uses for PioglitazoneType 2 Diabetes MellitusUsed alone or in combination with a sulfonylurea, metformin, or insulin as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus. Should be added to, not substituted for, other antidiabetic agents in patients whose type 2 diabetes mellitus is not adequately controlled by these agents.Current guidelines for the treatment of type 2 diabetes mellitus generally recommend metformin as first-line therapy in addition to lifestyle modifications in patients with recent-onset type 2 diabetes mellitus or mild hyperglycemia because of its well-established safety and efficacy (i.e., beneficial effects on glycosylated hemoglobin [hemoglobin A1c; HbA1c], weight, and cardiovascular mortality). In patients with metformin contraindications or intolerance (e.g., risk of lactic acidosis, GI intolerance) or in selected other patients, some experts suggest that initial therapy with a drug from another class of antidiabetic agents (e.g., a glucagon-like peptide-1 [GLP-1] receptor agonist, sodium-glucose cotransporter 2 [SGLT2] inhibitor, dipeptidyl peptidase-4 [DPP-4] inhibitor, sulfonylurea, thiazolidinedione, basal insulin) may be acceptable based on patient factors. May need to initiate therapy with 2 agents (e.g., metformin plus another drug) in patients with high initial HbA1c (>7.5% or ≥1.5% above target). In such patients with metformin intolerance, some experts suggest initiation of therapy with 2 drugs from other antidiabetic drug classes with complementary mechanisms of action. Consider early initiation of combination therapy for the treatment of type 2 diabetes mellitus to extend the time to treatment failure and more rapidly attain glycemic goals.For patients with inadequate glycemic control on metformin monotherapy, consider patient comorbidities (e.g., atherosclerotic cardiovascular disease [ASCVD], established kidney disease, heart failure), hypoglycemia risk, impact on weight, cost, risk of adverse effects, and patient preferences when selecting additional antidiabetic agents for combination therapy. Consider early introduction of insulin for severe hyperglycemia (e.g., blood glucose of ≥300 mg/dL or HbA1c >9–10%), especially if accompanied by catabolic manifestations (e.g., weight loss, hypertriglyceridemia, ketosis) or symptoms of hyperglycemia. Not used for the treatment of type 1 diabetes mellitus or diabetic ketoacidosis. Pioglitazone Dosage and AdministrationAdministrationOral AdministrationAdminister pioglitazone once daily without regard to meals.Administer fixed combination of pioglitazone and immediate-release metformin hydrochloride once or twice daily with meals to reduce the GI effects of metformin component.Administer fixed combination of pioglitazone and glimepiride once daily with the first main meal.DosageAvailable as pioglitazone hydrochloride; dosage expressed in terms of pioglitazone.If hypoglycemia
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