Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: pioglitazone
BRAND NAME: Actos
DRUG CLASS AND MECHANISM: Pioglitazone is an oral drug that reduces the amount of glucose (sugar) in the blood. It is in a class of anti-diabetic drugs called thiazolidinediones that are used in the treatment of type 2 diabetes. The other member in this class is rosiglitazone (Avandia). (Another member of this class, troglitazone or Rezulin, was removed from the market because of liver toxicity.) Patients with type 2 diabetes cannot make enough insulin, and the cells of their body respond less to the insulin that is produced. Since insulin is the hormone that stimulates cells to remove glucose from the blood, the reduced amount of insulin and its reduced effect cause cells to take up less glucose from the blood and the level of glucose in the blood to rise. Pioglitazone often is referred to as an "insulin sensitizer" because it attaches to the insulin receptors on cells throughout the body and causes the cells to become more sensitive (more responsive) to insulin. As a result, more glucose is removed from the blood, and the level of glucose in the blood falls. At least some insulin must be produced by the pancreas in order for pioglitazone to work. Pioglitazone also lowers the level of glucose in the blood by reducing the production and secretion of glucose into the blood by the liver. In addition, pioglitazone may alter the blood concentrations of lipids (fats) in the blood. Specifically, it decreases triglycerides and increases the "good" (HDL) cholesterol. Pioglitazone received FDA approval in July 1999.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 15, 30 and 45 mg.
STORAGE: Tablets should be kept at room temperature, 15-30 C (59-86 F).
PRESCRIBED FOR: Pioglitazone is used for the treatment of type 2 diabetes along with a healthy diabetic diet, regular exercise, weight control, smoking reduction, and careful monitoring of blood glucose. Pioglitazone may be used alone or in combination with metformin (Glucophage), a drug in a different class of anti-diabetic drugs, that also lowers blood glucose. Since it requires naturally-secreted insulin to be effective, pioglitazone is not recommended in type I diabetes where the amount of insulin is very low or absent. Nevertheless, pioglitazone is approved for treating type 2 diabetes in combination with insulin as well as another class of anti-diabetic drugs, the sulfonylureas, that increases the amount of insulin produced.
DOSING: Pioglitazone is prescribed once daily in doses ranging from 15 to 45 mg. The recommended starting dose for patients without heart failure is 15 or 30 mg and for those with heart failure it is 15 mg daily. Pioglitazone may be taken any time of the day, with or without meals. If a dose is missed on one day, two doses should not be taken the next day to make up for the missed dose.
DRUG INTERACTIONS: Gemfibrozil reduces the break down of pioglitazone by certain liver enzymes, increasing blood levels and possibly side effects of pioglitazone. The maximum dose of pioglitazone should not exceed 15 mg daily when combined with gemfibrozil or other drugs that reduce the activity of liver enzymes that break down pioglitazone. Conversely, rifampin increases the breakdown of pioglitazone by the liver, reducing blood levels and possibly the effects of pioglitazone.
PREGNANCY: There are no adequate studies of pioglitazone in pregnant women. Pioglitazone may be used in pregnancy if the physician feels the potential risks are justified.
NURSING MOTHERS: It is unknown if pioglitazone is secreted in breast milk. Therefore, the effect of pioglitazone on the nursing infant whose mother is taking pioglitazone is unknown.
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