SIDE EFFECTS: The most common side effects of pioglitazone alone or in combination with sulfonylureas, metformin, or insulin are:
- upper respiratory tract infection,
- muscle aches,
- tooth disorders,
- hypoglycemia, and
- sore throat.
In addition, dose related fluid accumulation (edema) can occur especially when combined with insulin. Fluid accumulation can worsen or lead to heart failure. Pioglitazone should not be used in patients with heart disease classified by the New York Heart Association (NYHA) as Class III and IV heart failure or symptomatic heart failure.
Fluid accumulation also may lead to macular edema, resulting in reduced vision. Pioglitazone also can reduce red blood cells.
There have been post-marketing reports of liver failure while taking pioglitazone.
Pioglitazone has been associated with liver injury. Periodic monitoring of liver-related side effects and liver tests should be conducted in patients taking pioglitazone.
Symptoms of liver injury are:
Pioglitazone should be stopped if patients have symptoms of liver injury and liver function test results that are greater than three times the normal level. Liver blood tests are obtained before starting treatment. Monitoring liver tests during treatment is not recommended for patients without liver disease.
Pioglitazone may cause ovulation in women who have stopped ovulating if they are premenopausal and insulin resistant. This may lead to pregnancy. For women (but not men) taking pioglitazone, there is an increased risk of bone fractures of the distal bones of the arm and leg. Patients taking pioglitazone should maintain proper bone health.
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