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.
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 safety to a
nursing infant when the mother is taking pioglitazone is unknown.
SIDE EFFECTS AND PRECAUTIONS: The most common side effects seen in clinical trials with pioglitazone alone or in
combination with sulfonylureas, metformin, or insulin were
upper respiratory tract infection, headache,
sinusitis, muscle aches, tooth disorders,
hypoglycemia, and sore throat. In addition, fluid accumulation
(edema) occurred in less than 5% of patients taking pioglitazone alone but
15% of patients taking pioglitazone and insulin (as compared with 2% and 7% of patients receiving placebo, respectively).
Fluid accumulation can lead to heart failure.
To date, no formal studies to evaluate drug interactions of pioglitazone with other drugs have been conducted. Nevertheless,
because it interacts with the liver enzymes that eliminate some other drugs, there is the potential for pioglitazone to increase
the elimination of such drugs as erythromycin,
calcium channel blockers (for
example,
diltiazem [Cardizem]), cisapride (Propulsid), corticosteroids, cyclosporine,
tacrolimus (Prograf), triazolam (Halcion), trimetrexate, and HMG-CoA reductase inhibitors (for
example, atorvastatin [Lipitor]). This would reduce their effectiveness.
Since another thiazolidinedione antidiabetic drug has been associated with liver injury, it is recommended that periodic monitoring of
liver-related side effects and liver function be done in patients taking pioglitazone. Side effects while taking pioglitazone which
may be due to liver injury include nausea, vomiting, abdominal pain, fatigue,
anorexia (loss of appetite), or dark urine. Liver blood tests also are
recommended during pioglitazone therapy.
Studies in the laboratory have shown that an anti-fungal drug, ketoconazole (Nizoral),
prevents the elimination of pioglitazone. This could lead to increased levels of pioglitazone and hypoglycemia (seriously reduced level
of sugar in the blood). Therefore, the manufacturer of pioglitazone recommends more frequent monitoring of blood sugar among patients
taking both pioglitazone and ketoconazole or the drugs related to ketoconazole,
fluconazole
(Diflucan) and itraconazole (Sporanox).
Pioglitazone may cause ovulation in women who have stopped ovulating if they are
pre-menopausal and insulin resistant.
This may lead to pregnancy.
Since studies of pioglitazone excluded patients with heart disease classified
by the New York Heart Association (NYHA) as Class III and IV (more serious
disease), it is not known how diabetics with serious heart disease will respond
to pioglitazone, particularly since it may lead to fluid accumulation and heart
failure.
For women (but not men) taking pioglitazone, there is an associated small risk of fracture of the distal bones of the arm and leg, amounting to approximately one additional fracture (as compared with placebo or other drugs) for every 100 years' use of pioglitazone. The reason for this association is not known.
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.
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