Pioglitazone

Green-G

Brand Name(s):Actos, Competact

Indication:Diabetes – Type 2

Rationale:

Considered:Feb-09

Review Date:May-22

Comments:
NICE NG28 Update Type 2 diabetes in adults: management
May 2017
…………………………
NICE guidelines [NG18]
Diabetes (type 1 and type 2) in children and young people: diagnosis and management
Full document available at:http://www.nice.org.uk/guidance/ng18
Aug 2015
…………………………
MHRA Safety Update – Pioglitazone: risk of bladder cancer
Summary
Use of pioglitazone is associated with a small increased risk of bladder cancer. Healthcare professionals should be aware of new warnings and precautions for use in at-risk patients

Advice for healthcare professionals:
Patients with active bladder cancer or with a history of bladder cancer, and those with uninvestigated haematuria, should not receive pioglitazone
Prescribers should review the safety and efficacy of pioglitazone in individuals after 3 to 6 months of treatment to ensure that only patients who are deriving benefit continue to be treated. Pioglitazone should be stopped in patients who do not respond adequately to treatment (eg, reduction in glycosylated haemoglobin, HbA1c)
Before starting pioglitazone, the following known risk factors for development of bladder cancer should be assessed in individuals: age; current or past history of smoking; exposure to some occupational or chemotherapy agents such as cyclophosphamide; or previous irradiation of the pelvic region
Use in elderly patients should be considered carefully before and during treatment because the risk of bladder cancer increases with age. Elderly patients should start on the lowest possible dose and be regularly monitored because of the risks of bladder cancer and heart failure associated with pioglitazone
Volume 5 Issue 1: August 2011

– Cases of cardiac failure have been reported when pioglitazone was used in combination with insulin, especially in patients with risk factors for the development of cardiac failure.
– If the combination is used, patients should be observed for signs and symptoms of heart failure, weight gain and oedema.
-Pioglitazone should be discontinued if any deterioration in cardiac status occurs.
MHRA Drug safety update Volume 4 Issue 6 January 2011