Administration of thiazolinedione with oral contraceptive containing ethinyl estradiol and norethindrone reduces the plasma concentration of both the hormones by approximately 30%, which could result in the loss of the contraceptive.

Caution to be excercised in patients receiving oral contraceptive.

In vitro, ketoconazole appears to significantly inhibit the metabolism of pioglitazone.

Patients receiving ketoconazole with pioglitazone should be evaluated.

Type II diabetes

INFORMATION - UPDATE-

PIOGLITAZONE - BANNED IN FRANCE-

The innovator of Pioglitazone , Takeda Pharmaceuticals , has issued additional warnings
on pioglitazone (sold as G-TASE, GLITA,GLIZONE-M,K-PIO-GM etc.)   . It states that-

Pioglitazone can cause fluid retension that precipitate or worsen congestive heart failure CHF
There is a 39 percent increase in the risk of CHF inpatients taking pioglitazone. It is not to be used in moderate to severe heart failure.

LFTs must be done before puoglitazone and periodically therafter. Patients must be told to
inform their doctors if there is weight gain, shortness of breath, nausea, vomiting, abdominal
pain , tiredness, loss of appetite , dark urine, or yellowing of skin.

CONCURRENT USE OF INSULIN-
 The Bristish Medicine and Healthcare Regulatory authority, ( MHRA) has warned that causes  of cardiac failure have been reported when pioglitazone was concurrently used with Insulin, especially in patients with risk factors for development of cardiac failure. If the combination is used, patients should be observed for signs and symptoms of heart failure and odema

Pioglitazone should be discontinued if any deterioration in cardiac status occurs.

The French drug agency AFSSAPS  has banned piogltazone due to the risk of developing
bladder cancer based on a study of 155,000 patients.

Germany has banned the use of Pioglitazone in new patientsThe drug was banned in india on June 18 but order revoked on July 31,2013

( MIMS )

Pharyngitis, oedema, headache, myalgia,

upper respiratory tract infection,sinnusitis, anemia.

Hypersensitivity, type 1 diabetes.

Special precautions:

Risk of hypoglycemia in patients receiving pioglitazone in combination with insulin or oral hypoglycemic agents. A reduction in dose may be necesary.

In premenopausal anovulatory patients with insulin resistence, thiazolidinedioones may result in resumption of ovulation. These patients may be at risk for pregnancy if adequate contraception is not used.

To be used with caution on patients with edema.

Caution in patients with hepatic dysfunction.

Monitor liver functions periodically

Pregnancy and lactation: Avoid unless the potential benefit outweighs the potential risk.

Pediatric patients- safety not established

Indication-

Type II diabetes

Dosage-

15 to 30mg once daily without regard to meals.

1.To be used with caution on patients with edema.

2.Caution in patients with hepatic dysfunction. Monitor liver functions periodically

3.Pregnancy and lactation: Avoid unless the potential benefit outweighs the potential risk.

4.Pediatric patients- safety not established

Can be taken without regard to meals

Pregnancy and lactation:

Avoid unless the potential benefit outweighs the potential risk.

Pediatric patients-

Safety not established