Before starting
Required
- Baseline
- HbA1c
- Liver function tests do not initiate if ALT greater than 2.5 x upper limit of normal or other evidence of liver disease
- Urinalysis to detect macroscopic haematuria; if present, investigate before starting
- Weight
Ongoing once stable
Consider
- 6 monthly
- HbA1c Discontinue if inadequate response after 3-6 months
- At least annually
- Liver function tests if ALT greater than 3 x upper limit of normal: reassess as soon as possible; discontinue if persists
- Periodically
- Weight weight gain may be due to fluid retention; a symptom of heart failure
Notes
Advice to patients
Advise patients to seek immediate medical attention if develop:
- symptoms such as nausea, vomiting, abdominal pain, fatigue, anorexia and dark urine develop
- visible haematuria or other urinary symptoms such as dysuria or urinary urgency
- disturbances in visual acuity (worsening or new onset macular oedema possible; consider ophthalmological referral)
Bibliography
- Mylan. Summary of Product Characteristics – Pioglitazone Mylan 15mg, 30mg, 45mg tablets. Last revised 03/2022 [cited 11/04/2024]
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [cited11/04/2024]
- NICE Clinical Knowledge Summaries (CKS). Diabetes – type 2. Updated March2024 [cited 11/04/2024]
- National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management [NG28]. Dec 2015[updated June 2022; cited11/04/2024]
- Medicines and Healthcare products Regulatory Agency. Insulin combined with pioglitazone: risk of cardiac failure. Drug Safety Update Jan 2011, vol 4 issue 6: A2 [cited11/04/2024]
- Medicines and Healthcare products Regulatory Agency. Pioglitazone: risk of bladder cancer. Drug Safety Update vol 5 issue 1, Aug 2011: A1 [cited11/04/2024]
Update history
- Baseline requirement for FBC removed, periodical weight requirement added; references updated.
- Published