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.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Pioglitazone is a 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 II 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 II diabetes cannot make enough insulin, and the cells of their body do not respond normally to the reduced amounts of
insulin that are present. (Insulin is the hormone produced by the pancreas that stimulates cells to remove glucose from the blood.)
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. 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 on July 16, 1999.
GENERIC AVAILABLE: no
PRESCRIPTION: 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 II 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 II diabetes in combination with insulin as well as another class of anti-diabetic drugs, the sulfonylureas.
DOSING: Pioglitazone is prescribed once daily in doses ranging from 15 to 45 mg. 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: To date, no formal studies to evaluate
drug interactions of pioglitazone with other drugs have been
conducted. However, since another thiazolidinedione that is similar to pioglitazone may reduce the effectiveness
of oral contraceptives
(potentially leading to pregnancy), caution should be used when using pioglitazone with an oral contraceptive.
Clinical studies using pioglitazone 15-45mg did not reveal changes in blood levels for the following
drugs: glipizide (Glucotrol), digoxin
(Lanoxin),
warfarin (Coumadin), or metformin
(Glucophage). In addition, the clotting of blood did not appear to be
changed enough by pioglitazone to require alterations in the doses of the blood thinner, warfarin.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
The main features of metabolic syndrome include insulin resistance, hypertension (high blood pressure), cholesterol abnormalities, and an increased risk for clotting. Patients are most often overweight or obese. Lifestyle modification such as the Mediterranean diet, exercise, and quitting smoking are the preferred treatment of metabolic syndrome.
The major goal in treating diabetes is to minimize any elevation of blood
sugar (glucose) without causing abnormally low levels of blood sugar. Type 1
diabetes is treated with insulin, exercise, and a
diabetic diet. Type 2 diabetes
is treated first with weight reduction, a diabetic diet, and exercise. When
these measures fail to control the elevated blood sugars, oral medications are
used. If oral medications are still insufficient, treatment with insulin is
considered.
Adherence to a diabetic diet is an important aspect of controlling elevated
blood sugar in patients with diabetes. The American Diabetes Association (ADA)
has provided guidelines for a diabetic diet. The ADA diet is a balanced,
nutritious diet that is low in fat, cholesterol, and simple sugars. The total
daily calories are evenly divided into three meals. In the past two years, the
ADA has lifted the absolute ban on simple sugars. Small amounts of si...
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