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