pioglitazone

(pie oh glit' ah zohn)

Actos

Pregnancy Category C

Drug classes
Antidiabetic
Thiazolidinedione

Therapeutic actions
Resensitizes tissues to insulin; stimulates insulin receptor sites to lower blood glucose
and improve the action of insulin; decreases hepatic gluconeogenesis and increases
insulin-dependent muscle glucose uptake.

Indications
• Monotherapy as an adjunct to diet and exercise to improve glucose control in
patients with type 2 (non–insulin-dependent) diabetes
• As part of combination with a sulfonylurea, metformin, or insulin when diet,
exercise plus a single agent alone does not result in adequate glycemic control in
type 2 diabetes

Contraindications and cautions

• Contraindicated with allergy to any thiazolidinedione; type 1 (insulin-dependent)
diabetes, ketoacidosis, lactation.
• Use cautiously with advanced heart disease, liver failure, pregnancy.

Available forms
Tablets—15, 30, 45 mg

Dosages
ADULTS
15–30 mg daily as a single oral dose; if adequate response is not seen, dosage may be
increased to a maximum 45 mg daily PO.
• Combination therapy with sulfonylurea or metformin: 15–30 mg daily PO added
to the established dose of the other agent; if hypoglycemia occurs, reduce the dose
of the other agent.
• Combination therapy with insulin: Initiate pioglitazone at 15 or 30 mg while
maintaining insulin dose. Decrease insulin dose by 10%–25% if hypoglycemic or
if glucose < 100 mg/dL.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Use caution and monitor patient closely. Do not administer if AST > 2.5 times the upper
level of normal.

Pharmacokinetics
Route Onset Peak
Oral Rapid 2–4 hr

Metabolism: Hepatic; T1/2: 3–7 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine, feces

Adverse effects
• CNS: Headache, pain, myalgia
• CV: Fluid retention
• Endocrine: Hypoglycemia, hyperglycemia, aggravated diabetes
• GI: Diarrhea, liver injury
• Respiratory: Sinusitis, URI, rhinitis
• Other: Infections, fatigue, tooth disorders

Interactions
Drug-drug
• Decreased effectiveness of hormonal contraceptives, which may result in
ovulation and risk of pregnancy; suggest the use of an alternative method of birth
control or consider a higher dose of the contraceptive
Drug-alternative therapy
• Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic,
fenugreek, coriander, dandelion root, celery

Nursing considerations
Assessment
• History: Allergy to any thiazolidinedione; type 1 diabetes, ketoacidosis, serious
hepatic impairment, advanced heart disease, pregnancy, lactation
• Physical: T; orientation, reflexes, peripheral sensation; R, adventitious sounds;
liver evaluation; liver function tests, blood glucose, CBC

Interventions
• Monitor urine or blood glucose levels frequently to determine effectiveness of
drug and dosage being used.
• Monitor baseline liver function tests before beginning therapy and periodically
during therapy.
• Administer without regard to meals.
• Arrange for consultation with dietitian to establish weight loss program and
dietary control as appropriate.
• Arrange for thorough diabetic teaching program to include disease, dietary
control, exercise, signs and symptoms of hypo- and hyperglycemia, avoidance of
infection, hygiene.

Teaching points
 • Do not discontinue this medication without consulting health care provider;
continue with diet and exercise program for diabetes control.
• Take this drug with meals. If dose is missed, it may be taken at the next meal. If
dose is missed for an entire day, do not double dose the next day.
• Monitor urine or blood for glucose and ketones as prescribed while adjusting to
drug.
• Use barrier contraceptives if currently taking hormonal contraceptives; these
drugs may be ineffective if combined with pioglitazone.
• Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-
colored stools, hypo- or hyperglycemic reactions.

Adverse effects in Italic are most common; those in Bold are life-threatening.