PioglitazonePioglitazone Hydrochloride

About Pioglitazone

Pioglitazone is a thiazolidinedione: it makes the body more sensitive to insulin. The label approves it, with diet and exercise, to improve blood sugar control in adults with type 2 diabetes; it is not for type 1 diabetes or diabetic ketoacidosis, and it is not recommended for children because of adverse effects seen in adults. It is taken once a day with or without food. The starting dose is 15 or 30 mg, or 15 mg with NYHA class I or II heart failure; the dose can rise in 15 mg steps to at most 45 mg a day, or at most 15 mg a day with gemfibrozil or another strong CYP2C8 inhibitor. It may take about two weeks for blood sugar to fall and two to three months for the full effect.

The boxed warning says thiazolidinediones, pioglitazone included, cause or worsen congestive heart failure in some patients, so people are watched for its signs after starting and after each dose increase, and if heart failure develops, stopping or lowering the dose is considered. Its fluid retention is dose-related and most common with insulin, and it can cause swelling and dose-related weight gain. Taken with insulin or a sulfonylurea, it can cause low blood sugar, so those doses may be lowered. Fatal and nonfatal liver failure has been reported, so liver tests are done before starting, and it is interrupted if tests suggest liver injury. It may be associated with a higher risk of bladder cancer: it is not used with active bladder cancer, and the benefits are weighed after past bladder cancer. Fractures were more common in women taking it in a large trial, and macular edema (swelling in the retina) has been reported, so anyone with vision changes is referred to an eye doctor. It must not be taken by anyone allergic to pioglitazone or an ingredient. Upper respiratory infections, headache, sinus infections, muscle pain and sore throat are the most common side effects.

Pioglitazone can cause ovulation in some premenopausal women who were not ovulating, so the chance of an unplanned pregnancy is discussed; data in pregnancy are not enough to judge the risk of birth defects or miscarriage, and it is not known whether it passes into breast milk. The Medication Guide asks people to report blood or a red color in the urine, an increased need to urinate or pain while urinating, which can be signs of bladder cancer, and swelling, shortness of breath, an unusually fast weight gain or unusual tiredness, which can be signs of heart failure. Combinations with metformin (Actoplus Met), glimepiride (Duetact) and alogliptin (Oseni) are separate products with their own labels, also sold under generic names; Actoplus Met XR, the 15/500 mg Actoplus Met and two Oseni strengths are discontinued.

Taking Pioglitazone

How to take it

Once a day at about the same time, with or without food. Keep taking it even if you feel well, and do not stop it without talking to the prescriber.

If you miss a dose

The Medication Guide says to take the next dose as prescribed unless your prescriber tells you otherwise. Do not take two doses at one time the next day.

Storage

At room temperature (68 to 77°F) in the container it came in, tightly closed, away from heat, light and moisture (not in the bathroom), out of reach of children.

Interactions to know about

Gemfibrozil and other strong CYP2C8 inhibitors raise pioglitazone levels, so its dose is capped at 15 mg a day with them, while rifampin can lower them. Insulin and sulfonylureas add to the risk of low blood sugar, insulin adds to fluid retention, and blood sugar control is watched with topiramate.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Pioglitazone differs from pharmacy to pharmacy

Generic pioglitazone rated equivalent to Actos comes from several makers, so a pharmacist can fill a prescription for either name with a generic unless the prescriber blocks substitution, and quotes for the same tablets differ in each pharmacy’s dispensing fee and markup. A prescription that names Actos and blocks substitution is filled with the brand and quoted for it.

The combination tablets are separate products: a prescription for one is not filled with the two medicines as separate tablets, or the reverse, without the prescriber, so compare quotes for the exact product and strength written.

Ways to pay less for Pioglitazone without insurance

• Ask for generic pioglitazone, and make sure the prescription does not block substitution.
• Ask whether pioglitazone is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is stable, ask the prescriber for a ninety-day supply.
• If you take Actoplus Met, Duetact or Oseni, ask the prescriber whether a generic version of the combination or the separate generic tablets would suit you, and ask for quotes on each.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Pioglitazone

1. 1.Which signs of heart failure, such as swelling or fast weight gain, mean I should call right away?
2. 2.When will my liver tests be checked, and which symptoms should I report?
3. 3.Should my insulin or sulfonylurea dose change while I take it?
4. 4.Given my history, should I talk about bladder cancer, fractures or my eyes before starting?

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