Pioglitazone is an oral diabetes medicine that help control blood sugar levels for people with type 2 diabetes mellitus or the non-insulin dependent diabetes mellitus (NIDDM). These people do not use daily insulin injections.
Special precautions: cardiac disease such as congestive heart failure (CHF) or a history of previous heart attack(myocardial infarction) or stroke; hepatic or liver disease; renal dysfunction; pituitary or adrenal insufficiency; malnutrition, irregular food intake, weakness; excessive alcohol intake; elderly; concomitant therapy with other antidiabetic agents. Do not use pioglitazone if you have type 1 diabetes mellitus or the insulin dependent diabetes mellitus or if you are in a state of diabetic ketoacidosis (a complication of type 1 DM).
Pioglitazone is usually taken once daily. Do not take this drug in smaller or larger amounts or even longer than what is recommended by your doctor. Do not take an extra drug if you missed a dose. It is important to take your medicine regularly as directed by your doctor. Take care not to let your blood sugar get too low, causing hypoglycemia. You may have hypoglycemia if you skip a meal, exercise too long, drink alcohol, or are under stress. It is important that you know the signs of hypoglycemia (low blood sugar) and know how to recognize them. These include: hunger, headache, confusion, irritability, drowsiness, weakness, dizziness, tremors, sweating, fast heartbeat, seizure (convulsions), fainting or coma. Always keep a source of sugar (orange juice, candy, glucose gel, milk) available in case you have symptoms of low blood sugar. Severe hypoglycemia is fatal and when you cannot drink or eat in this case, you need an emergency glucagons injection to raise your blood sugar level.
Pioglitazone may be harmful to an unborn baby (US FDA pregnancy category C). It is not known that pioglitazone passes into the breast milk or if it could harm a nursing baby. Therefore, do not start pioglitazone without informing your doctor if you are breast feeding. Avoid alcohol while you are taking this medicine because it further lowers the blood sugar and may lead to hypoglycemia.
Serious side effects: shortness of breath even with mild exertion; swelling or rapid weight gain; chest pain; nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); blurred vision; increased thirst or hunger; urinating more than usual; pale skin, easy bruising or bleeding or weakness. Less serious side effects: sneezing, runny nose, cough, headache, gradual weight gain, muscle pain or tooth problems.
Drugs that will antagonize the effect of pioglitazone are drugs that raises blood sugar such as the following: isoniazid; diuretics (water pills); steroids; phenothiazines; thyroid drugs (Synthroid); birth control pills and other hormones; seizure medicines (Dilantin); diet pills or medicines to treat asthma, colds or allergies.
Other drug interactions: Other antidiabetic drugs that may lower further the blood sugar. These include: nonsteroidal anti-inflammatory drugs (NSAIDs); aspirin or other salicylates (Pepto-Bismol); sulfa drugs (Bactrim); monoamine oxidase inhibitor (MAOI); beta-blockers (Tenormin and others); probenecid (Benemid) or a blood thinner (warfarin, Coumadin and others). Inform your doctor about any other prescription and over-the-counter medications you use. There may be other drugs not listed here that can affect pioglitazone.
Pioglitazone[(±)-5-[[4-[2-(5-ethyl-2-pyridinyl)ethoxy] phenyl]methyl]-2,4-] thiazolidine-dione monohydrochloride belongs to a different chemical class and has a different pharmacological action than the sulfonylureas, metformin, or the a-glucosidase inhibitors. The molecule contains one asymmetric carbon, and the compound is synthesized and used as the racemic mixture. The two enantiomers of pioglitazone interconvert in vivo. No differences were found in the pharmacologic activity between the two enantiomers. Pioglitazone hydrochloride is an odorless white crystalline powder that has a molecular formula of C19H20N2O3S•HCl and a molecular weight of 392.90 daltons. N,N-dimethylformamide, slightly soluble in anhydrous ethanol, very slightly soluble in acetone and acetonitrile, practically insoluble in water, and insoluble in ether. Pioglitazone is available as a tablet for oral administration containing 15 mg, 30 mg, or 45 mg of pioglitazone (as the base) formulated with the following excipients: lactose monohydrate NF, hydroxypropylcellulose NF, carboxymethylcellulose calcium NF, and magnesium stearate NF.
Pioglitazone has the following structural formula: