Safety Update On Pioglitazone

Pioglitazone improves glycaemic control but it is unclear whether it improves diabetes–related clinical complications and mortality. Prescribers should consider this — along with recently emerging safety information — when assessing the ratio of potential harms and benefits for each patient.

Pioglitazone is a third–line choice for treatment of type 2 diabetes mellitus. It can be considered when either metformin or a sulfonylurea is contraindicated or not tolerated. Insulin should also be considered instead of pioglitazone in either situation.
Pioglitazone is currently approved as combination therapy in patients with type 2 diabetes that is inadequately controlled with insulin.
Pioglitazone is associated with weight gain, oedema and fluid retention and should not be used in patients with moderate to severe heart failure.

An analysis of data in a clinical trial database has found an increased rate of fractures of the arm, hand and lower leg among women using pioglitazone.
Doses should not be increased until after 8 weeks of treatment, as the full effect of the drug may not be seen before this time. In clinical trials of glitazone treatment, 25% to 30% of patients had no improvement in glycaemic control.