6.1.2.4 Glitazones (thiazolidinediones)

ChoiceDrugDosage
Formulary choicePioglitazone tablets 15mg, 30mg, 45mgDose: Initially 15–30mg once daily, increased to 45mg once daily according to response

Prescribing Notes

  • Prescribe as per NICE Guideline NG28 recommendations. See also NICE Algorithm for blood glucose lowering therapy in adults with type 2 diabetes.
  • Do not commence or continue pioglitazone in people who have heart failure, or who are at higher risk of fracture, or who have bladder cancer (or a history of).
  • Liver function should be checked before initiating pioglitazone and periodically thereafter based on clinical judgement. It should not be initiated in anyone with ALT > 2.5 times the upper limit of normal or with other evidence of liver disease.
  • The balance of risks and benefits should be considered both before initiating and during treatment. Prescribers should review patients after three to six months (and regularly thereafter) to ensure only patients who are benefiting from treatment continue.
  • Competact® (pioglitazone and metformin) should be reserved for patients with demonstrable compliance problems. It is significantly more expensive than prescribing pioglitazone and metformin separately.

Cautions

  • Pioglitazone can cause significant weight gain and fluid retention. It must not be used in patients with heart failure or history of heart failure.
  • Macular oedema has been associated with use of pioglitazone.
  • Pioglitazone should not be used in patients with current or a history of bladder cancer or in patients with uninvestigated macroscopic haematuria. See EMA advice.
  • Do not commence/continue in people with a high risk of fracture (refer to FRAX or QFracture to assess risk).