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Pioglitazone: Drug information

Pioglitazone: Drug information
(For additional information see "Pioglitazone: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Congestive heart failure:

Thiazolidinediones, including pioglitazone, can cause or exacerbate congestive heart failure (CHF) in some patients. After initiation of pioglitazone, and after dose increases, observe patients carefully for signs and symptoms of heart failure (including excessive, rapid weight gain, dyspnea, and/or edema). If these signs and symptoms develop, manage the heart failure according to the current standards of care. Furthermore, discontinuation or dose reduction of pioglitazone must be considered.

Pioglitazone is not recommended in patients with symptomatic heart failure. Initiation of pioglitazone in patients with established New York Heart Association (NYHA) class III or IV heart failure is contraindicated.

Brand Names: US
  • Actos
Brand Names: Canada
  • ACCEL Pioglitazone [DSC];
  • ACH-Pioglitazone;
  • ACT Pioglitazone;
  • APO-Pioglitazone;
  • JAMP-Pioglitazone;
  • MINT-Pioglitazone;
  • PMS-Pioglitazone [DSC];
  • PRO-Pioglitazone [DSC];
  • SANDOZ Pioglitazone [DSC]
Pharmacologic Category
  • Antidiabetic Agent, Thiazolidinedione
Dosing: Adult

Note: May require a dose reduction of insulin secretagogues (sulfonylureas, meglitinides) to avoid hypoglycemia; consider discontinuation or dose reduction of insulin (Ref).

Diabetes mellitus, type 2, treatment

Diabetes mellitus, type 2, treatment:

Note: May be used as an adjunctive agent or alternative monotherapy for patients in whom initial therapy with lifestyle intervention and metformin failed or who cannot take metformin; may be preferred when avoidance of hypoglycemia is desirable. Use has been associated with an increased risk of heart failure, and risk is increased with concomitant insulin use (Ref). Avoid use in patients with preexisting heart failure (Ref).

Oral: Initial: 15 to 30 mg once daily.

Dosage adjustment: May increase in 15 mg/day increments every 4 to 12 weeks if needed to achieve glycemic goals (maximum: 45 mg/day) (Ref). Discontinue use if signs or symptoms of heart failure develop (Ref).

Insulin resistance/prediabetes, secondary prevention of atherosclerotic cardiovascular disease

Insulin resistance/prediabetes, secondary prevention of atherosclerotic cardiovascular disease (off-label use):

Note: May be used in patients with insulin resistance/prediabetes who have a history of stroke or transient ischemic attack (Ref).

Oral: Initial: 15 mg once daily. Increase in 15 mg/day increments every 4 weeks if tolerated to a target dose of 45 mg once daily. Discontinue use if signs or symptoms of heart failure develop (Ref).

Metabolic dysfunction associated steatohepatitis

Metabolic dysfunction associated steatohepatitis (off-label use):

Note: May consider use in patients with biopsy-confirmed metabolic dysfunction associated steatohepatitis who also have type 2 diabetes mellitus; treatment may also be considered in patients with prediabetes, though risks may more closely match benefits (Ref).

Oral: 30 mg once daily for 2 months, then increase dose to 45 mg once daily (Ref). Consider limiting dose to ≤30 mg/day if worsening heart failure is a concern (Ref); patients with cardiovascular disease were excluded from clinical trials (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: Mild to severe impairment: No dosage adjustment necessary (Ref).

Hemodialysis, intermittent (thrice weekly): Unlikely to be dialyzed; no supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Unlikely to be dialyzed due to high protein binding (expert opinion); no dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Adult

Hepatic impairment prior to initiation:

Patients without cirrhosis: No dosage adjustment necessary; use with caution if baseline liver tests are abnormal; some studies involving patients with metabolic dysfunction associated steatohepatitis (MASH) excluded patients with baseline LFTs (eg, AST, ALT) that were ≥2.5 to 3 times ULN (Ref). Once initiated, repeat LFTs periodically (eg, every 2 to 3 months) (Ref). Note: Studies in patients with MASH, with or without type 2 diabetes mellitus, excluded patients with other causes of liver disease (eg, hepatitis C, alcohol-associated fatty liver disease) (Ref).

Patients with cirrhosis: Use in patients with cirrhosis is not recommended (Ref); studies in patients with MASH, with or without type 2 diabetes mellitus, excluded patients with cirrhosis (Ref).

Hepatic impairment during therapy: Drug-induced liver injury associated with pioglitazone is rare (Ref). If liver injury is suspected (eg, fatigue, jaundice, dark urine), interrupt therapy, measure serum liver tests, and investigate possible etiologies:

If an alternative etiology is not identified and ALT >3 times ULN: Do not reinitiate therapy.

If an alternative etiology is identified and ALT elevated (but <3 times ULN) or total bilirubin elevated (but <2 times ULN): May reinitiate with caution.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions (Significant): Considerations
Bladder cancer

Pioglitazone may increase the risk of bladder carcinoma. A meta-analysis of randomized controlled trials and observational data support this association (Ref). Older data suggest the risk may be as high as 40% with duration >24 months and cumulative doses >28,000 mg (Ref).

Mechanism: Dose- and time-related; not clearly established but thought to be associated with activation of peroxisome proliferator activated receptor gamma (PPAR γ), which may alter tumor growth and progression in non-adipose cells (Ref).

Onset: Delayed; cases and risk generally occur with long-term use and high-dose exposure; however, there have been cases diagnosed within the first year of use (Ref).

Risk factors:

• Cumulative doses (>28,000 mg) (Ref)

• Duration of therapy (>24 months) (Ref)

• European ethnicity (Ref)

• Caucasian race (Ref)

• Prior history of bladder cancer

Fractures

Thiazolidinediones (TZDs) may increase the risk of bone fractures, but the risk associated with pioglitazone is conflicting. Analysis of safety data after 5 years of pioglitazone therapy in patients without diabetes from the Insulin Resistance Intervention after Stroke Trial (IRIS) showed an absolute risk increase of 1.6% to 4.9% and relative risk increase of 47% to 60%. Fractures were typically low energy, not related to stress or pathology, and not serious (ie, not requiring surgery or hospitalization) (Ref). Fractures were in the spine, rib, foot, fibula, radius, tibia, humerus, and hip with no one skeletal region more affected (Ref). In contrast, a meta-analysis of patients with type 2 diabetes mellitus found the risk of fracture comparable to other hyperglycemic agents (Ref). Cited explanations for a correlation from prior evidence include the study populations (ie, mostly older adults and post-menopausal females), as well as older TZDs used (Ref). Discontinuation of TZDs may attenuate adverse bone effects (Ref).

Mechanism: Time-related; TZDs activate peroxisome proliferator activated receptor gamma (PPAR γ) which is expressed in bone as well as various other tissues (Ref). Activation creates an imbalance of bone remolding, including changes in bone marrow structure and function (Ref). Additionally, TZDs have been associated with a decrease in estrogen synthesis, which may exacerbate the effects on bone metabolism (Ref).

Onset: Delayed; IRIS data indicates an increased risk after 2 years of pioglitazone therapy (Ref).

Risk factors:

• Duration of drug therapy (>2 years) (Ref)

• Older adults (Ref)

• Prior stroke (Ref)

• Retinopathy (Ref)

Heart failure/edema

Pioglitazone has been with associated with an increased risk of cardiac failure/worsening of cardiac failure and dose-dependent edema but has not been shown to have adverse effects on cardiac function structure (Ref). Symptoms are reversible with discontinuation (Ref).

Mechanism: Plasma volume increase appears to be the underlying etiology. Reduction in renal excretion of sodium and increase in sodium and free water retention is consistently thought of as the primary contributor to this plasma volume increase (Ref). Other exacerbating mechanisms could be increased sympathetic nervous system activity, alteration in endothelial permeability, and peroxisome proliferator activated receptor gamma (PPAR γ) mediated expression of vascular permeability growth factor (Ref).

Onset: Intermediate; within the first few weeks of initiation (Ref)

Risk factors:

• Presence of pedal edema or treatment with loop diuretics (Ref)

• Cardiovascular disease/significant aortic or mitral valve heart disease (Ref)

• Hypertension (Ref)

• Concurrent administration of drugs associated with fluid retention or pedal edema (Ref)

• Use with other glucose lowering therapies (especially insulin) (Ref)

• Older adults (>70 years) (Ref)

• Left ventricular hypertrophy (Ref)

• History of heart failure (Ref)

• Diabetes for >10 years (Ref)

• Chronic kidney failure (creatinine >2 mg/dL) (Ref)

Hepatic effects

Older thiazolidinediones (TZDs) have stronger evidence of liver injury and increased liver function tests than pioglitazone. Acute hepatic failure has been reported with pioglitazone (Ref). Resolution of symptoms may occur within 1 to 6 months of discontinuation (Ref). Pioglitazone (in combination with lifestyle modifications) has been shown to improve hepatic fat in patients with diabetes and liver histology, steatosis, and resolution of nonalcoholic fatty liver disease (NAFLD) in patients without diabetes (Ref).

Mechanism: Time-related; exact mechanism is unknown (Ref). Excess free fatty acids in the insulin resistant state may be directly toxic to hepatocytes (Ref), which may support the positive finding in NAFLD studies with pioglitazone (Ref).

Onset: Delayed; occurs 1 to 7 months after therapy initiation (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reactions and incidences reported are associated with monotherapy unless otherwise stated.

>10%:

Cardiovascular: Edema (3% to 27%; including exacerbation of edema) (table 1)

Pioglitazone: Adverse Reaction: Edema

Drug (Pioglitazone)

Placebo

Dose

Number of Patients (Pioglitazone)

Number of Patients (Placebo)

27%

15%

N/A

2,605

2,633

7%

1%

45 mg/day

169

259

5%

1%

30 mg/day

275

259

3%

1%

15 mg/day

81

259

Endocrine and metabolic: Hypoglycemia (27%)

Respiratory: Upper respiratory tract infection (13%)

1% to 10%:

Cardiovascular: Cardiac failure (8%; including worsening of heart failure) (table 2)

Pioglitazone: Adverse Reaction: Cardiac Failure

Drug (Pioglitazone)

Placebo

Number of Patients (Pioglitazone)

Number of Patients (Placebo)

8%

6%

2,605

2,633

Nervous system: Headache (9%)

Neuromuscular & skeletal: Back pain (6%), bone fracture (females: 5%; males: 2%) (table 3), myalgia (5%)

Pioglitazone: Adverse Reaction: Bone Fracture

Drug (Pioglitazone)

Placebo

Population

Number of Patients (Pioglitazone)

Number of Patients (Placebo)

5%

3%

Females

870

905

2%

2%

Males

N/A

N/A

Respiratory: Pharyngitis (5%), sinusitis (6%)

<1%:

Hematologic & oncologic: Bladder carcinoma (table 4)

Pioglitazone: Adverse Reaction: Bladder carcinoma

Drug (Pioglitazone)

Placebo

Number of Patients (Pioglitazone)

Number of Patients (Placebo)

0.5%

0.2%

2,605

2,633

Hepatic: Increased serum alanine aminotransferase

Neuromuscular & skeletal: Increased creatine phosphokinase in blood specimen

Frequency not defined:

Endocrine & metabolic: Decreased serum triglycerides, increased HDL cholesterol, weight gain

Hematologic & oncologic: Decreased hemoglobin

Postmarketing:

Hepatic: Hepatic failure (Floyd 2009)

Ophthalmic: Decreased visual acuity, macular edema (new-onset or worsening) (Oshitari 2008)

Contraindications

Hypersensitivity to pioglitazone or any component of the formulation; NYHA Class III/IV heart failure (initiation of therapy)

Canadian labeling: Additional contraindications (not is U.S. labeling): Any stage of heart failure (eg, NYHA Class I, II, III, IV); serious hepatic impairment; active bladder cancer; history of bladder cancer; uninvestigated macroscopic hematuria; pregnancy

Warnings/Precautions

Concerns related to adverse effects:

• Hematologic effects: May decrease hemoglobin/hematocrit; effects may be related to increased plasma volume.

• Hypoglycemia: The risk of hypoglycemia is increased when pioglitazone is combined with insulin or other diabetic medications; dosage adjustment of concomitant hypoglycemic agents may be necessary.

• Macular edema: Has been reported with thiazolidinedione use, including pioglitazone; some patients with macular edema presented with blurred vision or decreased visual acuity, and most had peripheral edema at time of diagnosis. Patients should be seen by an ophthalmologist if any visual symptoms arise during therapy and all diabetic patients should have regular eye exams.

• Weight gain: Dose-related weight gain observed with use; mechanism unknown but likely associated with fluid retention and fat accumulation.

Disease-related concerns:

• Bariatric surgery:

– Altered absorption: Absorption may be altered given the anatomic and transit changes created by gastric bypass and sleeve gastrectomy surgery (Mechanick 2020; Melissas 2013).

– Weight gain: Evaluate risk vs benefit and consider alternative therapy after gastric bypass, sleeve gastrectomy, and gastric banding; weight gain may occur (Apovian 2015).

• Diabetes, type 1: Mechanism requires the presence of insulin; therefore, use in type 1 diabetes or diabetic ketoacidosis is not recommended.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Actos: 15 mg, 30 mg, 45 mg

Generic: 15 mg, 30 mg, 45 mg

Generic Equivalent Available: US

Yes

Pricing: US

Tablets (Actos Oral)

15 mg (per each): $15.54

30 mg (per each): $23.75

45 mg (per each): $25.76

Tablets (Pioglitazone HCl Oral)

15 mg (per each): $7.01

30 mg (per each): $10.71 - $10.72

45 mg (per each): $11.61 - $11.63

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Generic: 15 mg, 30 mg, 45 mg

Administration: Adult

Oral: May be administered without regard to meals

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021073s049lbl.pdf#page=35, must be dispensed with this medication.

Use: Labeled Indications

Diabetes mellitus, type 2, treatment: As an adjunct to diet and exercise, to improve glycemic control in adults with type 2 diabetes mellitus

Use: Off-Label: Adult

Insulin resistance/prediabetes, secondary prevention of atherosclerotic cardiovascular disease; Metabolic dysfunction associated steatohepatitis

Medication Safety Issues
Sound-alike/look-alike issues:

Actos may be confused with Actidose, Actonel

International issues:

Tiazac: Brand name for pioglitazone [Chile], but also the brand name for dilTIAZem [U.S, Canada]

Metabolism/Transport Effects

Substrate of CYP2C8 (major), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Abiraterone Acetate: May enhance the hypoglycemic effect of Thiazolidinediones. Risk C: Monitor therapy

Alpha-Lipoic Acid: May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Androgens: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Beta-Blockers (Beta1 Selective): May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Beta-Blockers (Nonselective): May enhance the hypoglycemic effect of Antidiabetic Agents. Beta-Blockers (Nonselective) may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Bortezomib: May enhance the therapeutic effect of Antidiabetic Agents. Bortezomib may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

CYP2C8 Inducers (Moderate): May decrease the serum concentration of Pioglitazone. Risk C: Monitor therapy

CYP2C8 Inhibitors (Moderate): May increase the serum concentration of Pioglitazone. Risk C: Monitor therapy

CYP2C8 Inhibitors (Strong): May increase the serum concentration of Pioglitazone. Management: Limit the pioglitazone dose to 15 mg daily and monitor for increased pioglitazone toxicities (eg, hypoglycemia) when used in combination with strong CYP2C8 inhibitors. Risk D: Consider therapy modification

Direct Acting Antiviral Agents (HCV): May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Etilefrine: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Guanethidine: May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Hyperglycemia-Associated Agents: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Hypoglycemia-Associated Agents: Antidiabetic Agents may enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Risk C: Monitor therapy

Inhibitors of the Proton Pump (PPIs and PCABs): May enhance the adverse/toxic effect of Thiazolidinediones. Specifically, the risk of osteoporosis or fracture may be increased. Risk C: Monitor therapy

Insulins: Pioglitazone may enhance the adverse/toxic effect of Insulins. Specifically, the risk for hypoglycemia, fluid retention, and heart failure may be increased with this combination. Management: If insulin is combined with pioglitazone, consider insulin dose reductions to avoid hypoglycemia. Monitor patients for fluid retention and signs/symptoms of heart failure, and consider pioglitazone dose reduction or discontinuation if heart failure occurs Risk D: Consider therapy modification

Lumacaftor and Ivacaftor: May decrease the serum concentration of CYP2C8 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor and Ivacaftor may increase the serum concentration of CYP2C8 Substrates (High Risk with Inhibitors or Inducers). Risk C: Monitor therapy

Maitake: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Monoamine Oxidase Inhibitors: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Pegvisomant: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Pregabalin: May enhance the fluid-retaining effect of Thiazolidinediones. Risk C: Monitor therapy

Prothionamide: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Quinolones: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Quinolones may diminish the therapeutic effect of Agents with Blood Glucose Lowering Effects. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Risk C: Monitor therapy

Ritodrine: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Salicylates: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Sulfonylureas: Thiazolidinediones may enhance the hypoglycemic effect of Sulfonylureas. Management: Consider sulfonylurea dose adjustments in patients taking thiazolidinediones and monitor for hypoglycemia. Risk D: Consider therapy modification

Thiazide and Thiazide-Like Diuretics: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Topiramate: May decrease the serum concentration of Pioglitazone. Risk C: Monitor therapy

Reproductive Considerations

Thiazolidinediones may cause ovulation in anovulatory premenopausal patients, increasing the risk of unintended pregnancy.

Thiazolidinediones are not recommended for patients with type 2 diabetes mellitus planning to become pregnant. Patients who could become pregnant should use effective contraception during therapy. Transition to a preferred therapy should be initiated prior to conception and contraception should be continued until glycemic control is achieved (ADA 2023; Alexopoulos 2019; Egan 2020)

Pregnancy Considerations

Information related to the use of pioglitazone in pregnancy is limited (Glueck 2003; Ortega-Gonzalez 2005; Ota 2008).

Poorly controlled diabetes during pregnancy can be associated with an increased risk of adverse maternal and fetal outcomes, including diabetic ketoacidosis, preeclampsia, spontaneous abortion, preterm delivery, delivery complications, major malformations, stillbirth, and macrosomia. To prevent adverse outcomes, prior to conception and throughout pregnancy, maternal blood glucose and HbA1c should be kept as close to target goals as possible but without causing significant hypoglycemia (ADA 2023; Blumer 2013).

Agents other than pioglitazone are currently recommended to treat diabetes mellitus in pregnancy (ADA 2023).

Breastfeeding Considerations

It is not known if pioglitazone is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Dietary Considerations

Individualized medical nutrition therapy (MNT) based on American Diabetes Association recommendations is an integral part of therapy

Monitoring Parameters

Closely monitor for signs and symptoms of heart failure (eg, rapid weight gain, dyspnea, edema), particularly after initiation or dose increases or in NYHA class I or II (systolic) heart failure.

Type 2 diabetes mellitus, treatment:

Serum glucose.

HbA1c: Monitor at least twice yearly in patients who have stable glycemic control and are meeting treatment goals; monitor quarterly in patients in whom treatment goals have not been met, or with therapy change. Note: In patients prone to glycemic variability (eg, patients with insulin deficiency), or in patients whose HbA1c is discordant with serum glucose levels or symptoms, consider evaluating HbA1c in combination with blood glucose levels and/or a glucose management indicator (ADA 2023; KDIGO 2020).

Chronic therapy:

Liver enzymes (ALT, AST, alkaline phosphatase, and total bilirubin) prior to initiation in all patients (with or without liver disease); continue routine periodic monitoring during treatment only in patients with liver disease or suspected liver disease; monitor for signs/symptoms of liver injury closely.

Signs and symptoms of fluid retention or heart failure; weight gain; signs/symptoms of bladder cancer (dysuria, macroscopic hematuria, dysuria, urinary urgency); ophthalmic exams.

Reference Range

Recommendations for glycemic control in patients with diabetes:

Nonpregnant adults (ADA 2023, AACE [Samson 2023]):

HbA1c: <7% (a more aggressive [<6.5%] or less aggressive [<8%] HbA1c goal may be targeted based on patient-specific characteristics). Note: In patients using a continuous glucose monitoring system, a goal of time in range >70% with time below range <4% is recommended and is similar to a goal HbA1c <7%.

Preprandial capillary blood glucose: 80 to 130 mg/dL (SI: 4.4 to 7.2 mmol/L) (more or less stringent goals may be appropriate based on patient-specific characteristics).

Peak postprandial capillary blood glucose (~1 to 2 hours after a meal): <180 mg/dL (SI: <10 mmol/L) (more or less stringent goals may be appropriate based on patient-specific characteristics).

Older adults (≥65 years of age) (ADA 2023): Note: Consider less strict targets in patients who are using insulin and/or insulin secretagogues (sulfonylureas, meglitinides) (ES [LeRoith 2019]).

HbA1c: <7% to 7.5% (healthy); <8% (complex/intermediate health). Note: Individualization may be appropriate based on patient and caregiver preferences and/or presence of cognitive impairment. In patients with very complex or poor health (ie, limited remaining life expectancy), consider making therapy decisions based on avoidance of hypoglycemia and symptomatic hyperglycemia rather than HbA1c level.

Preprandial capillary blood glucose: 80 to 130 mg/dL (SI: 4.4 to 7.2 mmol/L) (healthy); 90 to 150 mg/dL (SI: 5 to 8.3 mmol/L) (complex/intermediate health); 100 to 180 mg/dL (SI: 5.6 to 10 mmol/L) (very complex/poor health).

Bedtime capillary blood glucose: 80 to 180 mg/dL (SI: 4.4 to 10 mmol/L) (healthy); 100 to 180 mg/dL (SI: 5.6 to 10 mmol/L) (complex/intermediate health); 110 to 200 mg/dL (SI: 6.1 to 11.1 mmol/L) (very complex/poor health).

Classification of hypoglycemia (ADA 2023):

Level 1: 54 to 70 mg/dL (SI: 3 to 3.9 mmol/L); hypoglycemia alert value; initiate fast-acting carbohydrate (eg, glucose) treatment.

Level 2: <54 mg/dL (SI: <3 mmol/L); threshold for neuroglycopenic symptoms; requires immediate action.

Level 3: Hypoglycemia associated with a severe event characterized by altered mental and/or physical status requiring assistance.

Mechanism of Action

Thiazolidinedione antidiabetic agent that lowers blood glucose by improving target cell response to insulin, without increasing pancreatic insulin secretion. It has a mechanism of action that is dependent on the presence of insulin for activity. Pioglitazone is a potent and selective agonist for peroxisome proliferator-activated receptor-gamma (PPARgamma). Activation of nuclear PPARgamma receptors influences the production of a number of gene products involved in glucose and lipid metabolism. PPARgamma is abundant in the cells within the renal collecting tubules; fluid retention results from stimulation by thiazolidinediones which increases sodium reabsorption.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Delayed

Peak effect: Glucose control: Several weeks

Distribution: Vd (apparent): 0.63 ± 0.41 L/kg

Protein binding: Pioglitazone >99% and active metabolites >98%; primarily to albumin

Metabolism: Hepatic (99%) via CYP2C8 and 3A4 to active and inactive metabolites; M-III and M-IV are major circulating active metabolites

Half-life elimination: Parent drug: 3 to 7 hours; M-III and M-IV metabolites: 16 to 24 hours

Time to peak: ~2 hours; delayed with food

Excretion: Urine (15% to 30%) and feces as metabolites

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Actos | Glacera | Glados | Glustin | Ipoz | Pio | Pioglin;
  • (AR) Argentina: Actos | Cereluc | Diaben P | Pioglit | Zatium;
  • (AT) Austria: Actos | Pioglitazon Accord | Pioglitazon G.L. | Pioglitazon Hexal | Pioglitazon Stada | Pioglitazon Teva | Pioglitazone Actavis;
  • (AU) Australia: Acpio | Actaze | Actos | Apo pioglitazone | Cm Pioglitazone | Noumed pioglitazone | Pharmacor pioglitazone | Pioglitazone an | Pioglitazone GA | Pioglitazone pfizer | Pioglitazone sandoz | Pizaccord | Prioten | Terry white chemists pioglitazone | Vexazone;
  • (BD) Bangladesh: Actose | Adpas | Diaglit | Diatus | Glitazon | Glucozon | Lit | Ogli | Pidus | Piglit | Piodar | Pioglin | Piol | Piolit | Piozena | Tos;
  • (BE) Belgium: Actos;
  • (BG) Bulgaria: Lispecip | Pizona;
  • (BR) Brazil: Actos | Aglitil | Clo pioglitazo | Cloridrato de pioglitazona | Glicopio | Pioglit | Piotaz | Stanglit;
  • (CH) Switzerland: Actos | Pioglitazon Actavis | Pioglitazon Mepha | Pioglitazon Mepha Teva | Pioglitazon sandoz;
  • (CI) Côte d'Ivoire: Diaglycan | Pionorm;
  • (CL) Chile: Actos | Diabestat | Tiazac | Zatium;
  • (CN) China: Actins | Actos | Actus | Ai ke ta | Ai ting | Duo ying | Ka si ping | Kai bao wei yuan | Ke cheng | Lie luo | Rui tong;
  • (CO) Colombia: Actos | Duplot | Glucemin;
  • (CZ) Czech Republic: Actos | Novapio | Pioglitazon Actavis | Pioglitazon apotex | Pioglitazon Mylan | Pioglitazone accord | Pioglitazone Teva;
  • (DE) Germany: Actos | Pioglitazon Aurobindo | Pioglitazon micro;
  • (DO) Dominican Republic: Actos | Zatium;
  • (EC) Ecuador: Actos | Zatium;
  • (EE) Estonia: Pioglitazone accord | Pioglitazone Teva | Zipion;
  • (EG) Egypt: Actos | Actozone | Diabetin | Diabetonorm | Ensudyne | Glustazon | Glustin | Hi glitazone;
  • (ES) Spain: Actos | Glustin | Pioglitazona accord | Pioglitazona Actavis | Pioglitazona Aurobindo | Pioglitazona aurovitas | Pioglitazona Cinfa | Pioglitazona edigen | Pioglitazona Kern | Pioglitazona normon | Pioglitazona Sandoz | Pioglitazona Stada | Pioglitazona Tecnigen | Pioglitazona Teva;
  • (FI) Finland: Actos | Pioglitazon orion | Pioglitazone accord | Pioglitazone Actavis | Pioglitazone sandoz | Pioglitazone Teva;
  • (FR) France: Actos;
  • (GB) United Kingdom: Actos | Glidipion | Pioglitazone;
  • (GR) Greece: Actos | Glitact | Glizon | Pioglitazone mylan | Pioglitazone sandoz | Raglitan | Sahar | Zipion;
  • (HK) Hong Kong: Actos | Apo pioglitazone | Glitter | Pioglitazone | Pioglitazone Actavis | Pms pioglitazone | Zolid;
  • (HR) Croatia: Actos | Pioglitazon Pliva | Pioglitazone Teva;
  • (ID) Indonesia: Actos | Gliabetes | Opiglit | Pioglitazone | Pioglitazone HCL | Pionix | Prabetic | Tazovell;
  • (IE) Ireland: Actos | Pioglitazone | Pioglitazone accord;
  • (IN) India: Adglim p | Alpiozon | Betapride | Biodib | Cureglit | Diaglit | Diavista | Dibizone | Drpg | G-tase | Geoglit | Glita | Glitaris | Glitase | Glitastar | Glito | Glitter | Glizone | Glufit | Glycopy | Gp | K-pio | Lupiglit | Oglo | Opam | P-glitz | Path | Pazo | Pepar | Pio-g | Piobir | Piocon | Piodart | Piofix | Pioglar | Pioglaz | Pioglit | Pioglitex | Pioglu | Piohope | Piokap | Piokind | Piolee | Piolem | Piolet | Pioli | Piomed | Piomerc | Piomeri | Pioneer | Pionorm | Piopar | Piopill | Piopod | Piorest | Piosafe | Pioshine | Piostar | Piosys | Piotab | Piotaz | Piotop | Piotrex | Piotrol | Pioz | Piozed | Piozit | Piozone | Piozulin | Pizone | Pizorad | Posinorm | Pozitiv | Precitrol | Pye | Pywohn | Pzone | Pzvio | Sensitab | Wonglita | Zipio;
  • (IT) Italy: Actos | Glustin | Pioglitazone accord | Pioglitazone Actavis | Pioglitazone aurobindo | Pioglitazone Doc | Pioglitazone sandoz | Pioglitazone tecnimede | Pioglitazone Zentiva;
  • (JO) Jordan: Actos;
  • (JP) Japan: Actos | Pioglitazone | Pioglitazone ffp | Pioglitazone Meiji | Pioglitazone sandoz;
  • (KE) Kenya: Glitas | Glitter | Glizone | Glustin | Nilgar | Pioday | Pioglit | Piogluc | Pionorm | Piosafe | Piozer;
  • (KR) Korea, Republic of: Acgli | Acpio | Acstazone | Acstin | Actazon | Acti-M | Actiem m | Actigly | Actilazone | Actodia | Actogreen | Actopin | Actopis | Actorin | Actos | Actozon | Antos | Atos | Bmi pioglitazone | C tos | Daewoong pioglitazone | Dai act | Dibezone | Dmmet | Dmzone | Emcon | Glezon | Gliact | Glidia | Glitazone | Glitos | Glizone | Gluconon | Glustop | Glutazone | Glyact | Glyta | Greepin | Grutazone | Hypio | Inno.n pioglitazone | K tos | Kaytos | Kukje pioglitazone | New piolita | Newpio | Oglita | Pactos | Pazone | Pictos | Pigli | Piglito | Pigrion | Pigzone | Pioacti | Piodia | Piodin | Piogla | Piogle | Piogli | Pioglin | Pioglisu | Pioglita | Pioglitazone | Pioglon | Pioglu | Piogrin | Piolex | Piolidone | Piolizone | Piomax | Piomed | Piomin | Piona | Piopin | Piora | Pioren | Piorex | Piori | Pioridon | Piorigle | Piorin | Piorita | Pioron | Pios | Piosc | Piot | Piota | Piotazone | Piotic | Piotin | Piotos | Piovex | Piozol | Piozole | Pirizone | Piros | Pitazone | Samsung pioglitazone | Uran | Yulan | Yungjin glitzone;
  • (KW) Kuwait: Actos | Glados | Glustin;
  • (LB) Lebanon: Actos | Piodiab | Uniglit;
  • (LT) Lithuania: Actos | Pioglitazone accord | Pioglitazone HCL | Pioglitazone Torrent | Zipion;
  • (LU) Luxembourg: Actos;
  • (LV) Latvia: Actos | Pioglitazone accord | Pioglitazone Teva | Zipion;
  • (MA) Morocco: Glitex;
  • (MX) Mexico: Accotaz | Agopar | Deglutzina | Diazatos | Gliozac | Glitacar 1 | Mopro d | Pioglitazona | Pioglitazona antibioticos | Pioglitazona bayer | Pioglitazona biomep | Pioglitazona sanofi-aventis | Pizubet | Plagox | Plitoran | Reazyd | Zactos | Zetric | Zigalta;
  • (MY) Malaysia: Actos | Piolet;
  • (NG) Nigeria: Eden pioglitazone | Nilgar | Piogista | Pionorm | Plutone | Zolital;
  • (NL) Netherlands: Actos | Pioglitazon | Pioglitazon sandoz | Pioglitazon Teva Pharma;
  • (NO) Norway: Actos | Pioglitazone accord | Pioglitazone Teva;
  • (NZ) New Zealand: Actos | Noumed pioglitazone | Vexazone;
  • (PE) Peru: Actos | Diabestat | Piolet | Piolet-30 | Tiazac | Zatium;
  • (PH) Philippines: Actazone | Actos | Glipitone | Glitaz | Glito | Glitter | Insulact | Pio source | Piodart | Piogen | Pioglifar | Pioglitazone | Pioglon | Piolit | Piorance | Piostal | Piotaz | Piouno | Piozar | Piozulin | Ppar | Prialta | Utmos 15l | Zeal;
  • (PK) Pakistan: Diglyta | Gliden | Gliter | Glitlite | Glyrol | Oglo | Piobar | Piobetic | Pioglance | Piokure | Piozer | Tagozer | Zolid;
  • (PL) Poland: Actos | Pioglitazone accord | Pioglitazone bioton;
  • (PR) Puerto Rico: Actos | Pioglitazone | Pioglitazone HCL;
  • (PT) Portugal: Actos | Glustin | Pioglitazon ratiopharm | Pioglitazona accord | Pioglitazona Actavis | Pioglitazona Aristo | Pioglitazona Aurobindo | Pioglitazona aurovitas | Pioglitazona bluepharma | Pioglitazona Ciclum | Pioglitazona Cinfa | Pioglitazona farmoz | Pioglitazona generis | Pioglitazona Sandoz | Pioglitazona sarb | Pioglitazona tetrafarma | Pioglitazona Teva Pharma | Pioglitazona Zentiva | Pyadiab;
  • (PY) Paraguay: Diabefarm | Glita | Glizona | Pioglit | Pioglitazona 30 mg intas | Pioglitazona prosalud;
  • (QA) Qatar: Actos | Glit | Uniglit;
  • (RO) Romania: Actos | Glidipion | Lispecip | Pioglitazone accord | Zipion;
  • (RU) Russian Federation: Actos | Amalvia | Astrozone | Diab-norm | Diaglitazon | Pioglar | Pioglit;
  • (SA) Saudi Arabia: Actos | Apo pioglitazone | Glados | Gleran | Glustin | Ogliton | Pms pioglitazon;
  • (SE) Sweden: Actos | Pioglitazon orion | Pioglitazone | Pioglitazone accord | Pioglitazone Actavis | Pioglitazone teva pharma;
  • (SG) Singapore: Pioglitazone;
  • (SK) Slovakia: Pioglitazone accord | Pioglitazone Actavis;
  • (TH) Thailand: Actos | Gitazone | Gitazone Forte | Glubosil | Militos | Piozone | Senzulin | Utmos;
  • (TN) Tunisia: Actos;
  • (TR) Turkey: Actos | Dropia | Dyndion | Glifix | Pioforce | Piofox | Piogtan | Piondia | Pixart;
  • (TW) Taiwan: Actos | Befree | Beglipin | Diazone | Glitis | Glufit | Piosugar | Piota | Piozon | Pitazone | Politone;
  • (UA) Ukraine: Glutason | Nilgar | Pionorm | Pioz;
  • (UG) Uganda: Piogen | Piosafe | Zoliglit;
  • (UY) Uruguay: Higlucem | Pacilan | Pioglit | Piomed;
  • (VE) Venezuela, Bolivarian Republic of: Asglipen;
  • (ZA) South Africa: Accord pioglitazone | Actos | Cipla Pioglitazone;
  • (ZM) Zambia: Glitter | Piomed | Pioz | Piozulin
  1. 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372 [PubMed 37139824]
  2. Actos (pioglitazone) [prescribing information]. Lexington, MA: Takeda Pharmaceuticals America, Inc; June 2020.
  3. Act Pioglitazone (pioglitazone) [product monograph]. Toronto, Ontario, Canada: Takeda Canada Limited; February 2020.
  4. Aghamohammadzadeh N, Niafar M, Dalir Abdolahinia E, et al. The effect of pioglitazone on weight, lipid profile and liver enzymes in type 2 diabetic patients. Ther Adv Endocrinol Metab. 2015;6(2):56-60. doi:10.1177/2042018815574229 [PubMed 25941563]
  5. Aithal GP, Thomas JA, Kaye PV, et al. Randomized, placebo-controlled trial of pioglitazone in nondiabetic subjects with nonalcoholic steatohepatitis. Gastroenterology. 2008;135(4):1176-1184. doi:10.1053/j.gastro.2008.06.047 [PubMed 18718471]
  6. Alexopoulos AS, Blair R, Peters AL. Management of preexisting diabetes in pregnancy: a review. JAMA. 2019;321(18):1811-1819. doi:10.1001/jama.2019.4981 [PubMed 31087027]
  7. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 201: Pregestational diabetes mellitus. Obstet Gynecol. 2018;132(6):e228-e248. doi:10.1097/AOG.0000000000002960 [PubMed 30461693]
  8. American Diabetes Association. 11. Older adults: standards of medical care in diabetes-2018. Diabetes Care. 2018b;41(suppl 1):S119-S125. doi:10.2337/dc18-S011 [PubMed 29222382]
  9. American Diabetes Association (ADA). Standards of care in diabetes–2023. Diabetes Care. 2022;46(suppl 1):S1-S4. https://diabetesjournals.org/care/issue/46/Supplement_1. Accessed June 19, 2023.
  10. Apovian CM, Aronne LJ, Bessesen DH, et al; Endocrine Society. Pharmacological management of obesity: an Endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2015;100(5):2135-2136]. J Clin Endocrinol Metab. 2015;100(2):342-362. doi:10.1210/jc.2014-3415 [PubMed 25590212]
  11. Azoulay L, Yin H, Filion KB, et al. The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study. BMJ. 2012;344:e3645. doi:10.1136/bmj.e3645 [PubMed 22653981]
  12. Belfort R, Harrison SA, Brown K, et sl. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. 2006;355(22):2297-2307. doi:10.1056/NEJMoa060326 [PubMed 17135584]
  13. Berthet S, Olivier P, Montastruc JL, Lapeyre-Mestre M. Drug safety of rosiglitazone and pioglitazone in France: a study using the French PharmacoVigilance database. BMC Clin Pharmacol. 2011;11:5. doi:10.1186/1472-6904-11-5 [PubMed 21609444]
  14. Blazina I, Selph S. Diabetes drugs for nonalcoholic fatty liver disease: a systematic review. Syst Rev. 2019;8(1):295. doi:10.1186/s13643-019-1200-8 [PubMed 31783920]
  15. Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227-4249. [PubMed 24194617]
  16. Bril F, Kalavalapalli S, Clark VC, et al. Response to pioglitazone in patients with nonalcoholic steatohepatitis with vs without type 2 diabetes. Clin Gastroenterol Hepatol. 2018;16(4):558-566.e2. doi:10.1016/j.cgh.2017.12.001 [PubMed 29223443]
  17. Budde K, Neumayer HH, Fritsche L, Sulowicz W, Stompôr T, Eckland D. The pharmacokinetics of pioglitazone in patients with impaired renal function. Br J Clin Pharmacol. 2003;55(4):368-74. doi:10.1046/j.1365-2125.2003.01785.x [PubMed 12680885]
  18. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357. doi:10.1002/hep.29367 [PubMed 28714183]
  19. Cusi K, Orsak B, Bril F, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med. 2016;165(5):305-315. doi:10.7326/M15-1774 [PubMed 27322798]
  20. Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701. doi:10.2337/dci18-0033 [PubMed 30291106]
  21. de Jong M, van der Worp HB, van der Graaf Y, Visseren FLJ, Westerink J. Pioglitazone and the secondary prevention of cardiovascular disease. A meta-analysis of randomized-controlled trials. Cardiovasc Diabetol. 2017;16(1):134. doi:10.1186/s12933-017-0617-4 [PubMed 29037211]
  22. Dormandy JA, Charbonnel B, Eckland DJ, et al; PROactive Investigators. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005;366(9493):1279-1289. doi:10.1016/S0140-6736(05)67528-9 [PubMed 16214598]
  23. Eckland DA, Danhof M. Clinical pharmacokinetics of pioglitazone. Exp Clin Endocrinol Diabetes. 2000;108(suppl 2):S234-S242.
  24. Egan AM, Dow ML, Vella A. A review of the pathophysiology and management of diabetes in pregnancy. Mayo Clin Proc. 2020;95(12):2734-2746. doi:10.1016/j.mayocp.2020.02.019 [PubMed 32736942]
  25. European Association for the Study of the Liver (EASL); European Association for the Study of Diabetes (EASD); European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388-1402. doi:10.1016/j.jhep.2015.11.004 [PubMed 27062661]
  26. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  27. Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-sponsored 3rd PCOS consensus workshop group. Fertil Steril. 2012;97(1):28-38. [PubMed 22153789]
  28. Floyd JS, Barbehenn E, Lurie P, Wolfe SM. Case series of liver failure associated with rosiglitazone and pioglitazone. Pharmacoepidemiol Drug Saf. 2009;18(12):1238-1243. doi:10.1002/pds.1804 [PubMed 19623674]
  29. Garber AJ, Handelsman Y, Grunberger G, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2020 executive summary. Endocr Pract. 2020;26(1):107-139. doi:10.4158/CS-2019-0472 [PubMed 32022600]
  30. Glueck CJ, Moreira A, Goldenberg N, et al. Pioglitazone and Metformin in Obese Women With Polycystic Ovary Syndrome Not Optimally Responsive to Metformin. Hum Reprod. 2003;18(8):1618-1625. [PubMed 12871871]
  31. Hu D, Wu CQ, Li ZJ, et al. Characterizing the mechanism of thiazolidinedione-induced hepatotoxicity: an in vitro model in mitochondria. Toxicol Appl Pharmacol. 2015;284(2):134-141. doi:10.1016/j.taap.2015.02.018 [PubMed 25727309]
  32. Inzucchi SE. Thiazolidinediones in the treatment of type 2 diabetes mellitus. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed October 13, 2021.
  33. Jearath V, Vashisht R, Rustagi V, Raina S, Sharma R. Pioglitazone-induced congestive heart failure and pulmonary edema in a patient with preserved ejection fraction. J Pharmacol Pharmacother. 2016;7(1):41-43. doi:10.4103/0976-500X.179363 [PubMed 27127397]
  34. Kernan WN, Viscoli CM, Furie KL, et al; IRIS Trial Investigators. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374(14):1321-1331. doi:10.1056/NEJMoa1506930 [PubMed 26886418]
  35. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2020 clinical practice guideline for diabetes management in chronic kidney disease. Kidney Int. 2020;98(suppl 4):S1-S115. doi:10.1016/j.kint.2020.06.019 [PubMed 32998798]
  36. Kirkman M, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342-2356. doi:10.1111/jgs.12035 [PubMed 23106132]
  37. LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of diabetes in older adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1520-1574. doi:10.1210/jc.2019-00198 [PubMed 30903688]
  38. Marcy TR, Britton ML, Blevins SM. Second-generation thiazolidinediones and hepatotoxicity. Ann Pharmacother. 2004;38(9):1419-1423. doi:10.1345/aph.1E072 [PubMed 15266041]
  39. May LD, Lefkowitch JH, Kram MT, Rubin DE. Mixed hepatocellular-cholestatic liver injury after pioglitazone therapy. Ann Intern Med. 2002;136(6):449-452. doi:10.7326/0003-4819-136-6-200203190-00008 [PubMed 11900497]
  40. Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, the Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175-247. doi:10.1016/j.soard.2019.10.025 [PubMed 31917200]
  41. Melissas J, Leventi A, Klinaki I, et al. Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study. Ann Surg. 2013;258(6):976-982. doi:10.1097/SLA.0b013e3182774522 [PubMed 23160151]
  42. Mudaliar S, Chang AR, Henry RR. Thiazolidinediones, peripheral edema, and type 2 diabetes: incidence, pathophysiology, and clinical implications. Endocr Pract. 2003;9(5):406-416. doi:10.4158/EP.9.5.406 [PubMed 14583425]
  43. Nesto RW, Bell D, Bonow RO, et al. Thiazolidinedione use, fluid retention, and congestive heart failure: a consensus statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2004;27(1):256-263. doi:10.2337/diacare.27.1.256 [PubMed 14693998]
  44. Ortega-Gonzalez C, Cardoza L, Coutino B, et al. Insulin Sensitizing Drugs Increase the Endogenous Dopaminergic Tone in Obese Insulin-Resistant Women With Polycystic Ovary Syndrome. J Endocrinol. 2005;184(1):233-239. [PubMed 15642799]
  45. Ota H, Goto T, Yoshioka T, et al. Successful Pregnancies Treated With Pioglitazone in Infertile Patients With Polycystic Ovary Syndrome. Fertil Steril. 2008;90(3):709-713. [PubMed 18423625]
  46. Pavlova V, Filipova E, Uzunova K, Kalinov K, Vekov T. Pioglitazone therapy and fractures: Systematic review and meta-analysis. Endocr Metab Immune Disord Drug Targets. 2018;18(5):502-507. doi:10.2174/1871530318666180423121833 [PubMed 29683100]
  47. Practice Committee of American Society for Reproductive Medicine. Use of Insulin-Sensitizing Agents in the Treatment of Polycystic Ovary Syndrome. Fertil Steril. 2008;90(5)(suppl):S69-S73. [PubMed 19007650]
  48. Razavizade M, Jamali R, Arj A, Matini SM, Moraveji A, Taherkhani E. The effect of pioglitazone and metformin on liver function tests, insulin resistance, and liver fat content in nonalcoholic Fatty liver disease: a randomized double blinded clinical trial. Hepat Mon. 2013;13(5):e9270. doi:10.5812/hepatmon.9270 [PubMed 23930133]
  49. Refer to manufacturer's labeling.
  50. Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology consensus statement: comprehensive type 2 diabetes management algorithm - 2023 update. Endocr Pract. 2023;29(5):305-340. doi:10.1016/j.eprac.2023.02.001 [PubMed 37150579]
  51. Sanyal AJ, Chalasani N, Kowdley KV, et al; NASH CRN. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med. 2010;362(18):1675-1685. doi:10.1056/NEJMoa0907929 [PubMed 20427778]
  52. Scheen AJ. Pharmacokinetic and toxicological considerations for the treatment of diabetes in patients with liver disease. Expert Opin Drug Metab Toxicol. 2014;10(6):839-857. doi:10.1517/17425255.2014.902444 [PubMed 24669954]
  53. Scheen AJ. Thiazolidinediones and liver toxicity. Diabetes Metab. 2001;27(3):305-313. [PubMed 11431595]
  54. Spence JD, Viscoli CM, Inzucchi SE, et al; IRIS Investigators. Pioglitazone therapy in patients with stroke and prediabetes: a post hoc analysis of the IRIS randomized clinical trial. JAMA Neurol. 2019;76(5):526-535. doi:10.1001/jamaneurol.2019.0079 [PubMed 30734043]
  55. Tang WH, Francis GS, Hoogwerf BJ, Young JB. Fluid retention after initiation of thiazolidinedione therapy in diabetic patients with established chronic heart failure. J Am Coll Cardiol. 2003;41(8):1394-1398. doi:10.1016/s0735-1097(03)00159-1 [PubMed 12706937]
  56. Tang H, Shi W, Fu S, et al. Pioglitazone and bladder cancer risk: a systematic review and meta-analysis. Cancer Med. 2018;7(4):1070-1080. doi:10.1002/cam4.1354 [PubMed 29476615]
  57. Tolman KG, Freston JW, Kupfer S, Perez A. Liver safety in patients with type 2 diabetes treated with pioglitazone: results from a 3-year, randomized, comparator-controlled study in the US. Drug Saf. 2009;32(9):787-800. doi:10.2165/11316510-000000000-00000 [PubMed 19670918]
  58. Viscoli CM, Inzucchi SE, Young LH, et al; IRIS Trial Investigators. Pioglitazone and risk for bone fracture: Safety data from a randomized clinical trial. J Clin Endocrinol Metab. 2017;102(3):914-922. doi:10.1210/jc.2016-3237 [PubMed 27935736]
  59. Yen FS, Hsu CC, Wei JC, Hou MC, Hwu CM. Selection and warning of evidence-based antidiabetic medications for patients with chronic liver disease. Front Med (Lausanne). 2022;9:839456. doi:10.3389/fmed.2022.839456 [PubMed 35252271]
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