Pioglitazone

Pharmacologic Category

Antidiabetic Agent, Thiazolidinedione

Dosing: Adult

Diabetes mellitus, type 2: Oral:

Initial: 15 to 30 mg once daily.

Patients with asymptomatic NYHA class I or II heart failure (HF): Initiate cautiously with 15 mg once daily. Note: Not recommended in patients with symptomatic HF and contraindicated with stage III or IV HF; the ADA generally recommends avoiding thiazolidinediones in the setting of HF (ADA 2019).

Dosage titration: Based on HbA_1c, the dosage may be increased in 15 mg increments with careful monitoring of adverse effects (eg, weight gain, edema, signs/symptoms of HF) up to a maximum of 45 mg once daily; consider limiting dose to ≤30 mg/day if worsening HF is a concern (AACE/ACE [Garber 2019]).

Dosage adjustment for hypoglycemia with combination therapy:

With an insulin secretagogue (eg, sulfonylurea): Decrease the insulin secretagogue dose.

With insulin: Decrease insulin dose by 10% to 25%; individualize further adjustments per glycemic response.

Dosage adjustment with strong CYP2C8 inhibitors (eg, gemfibrozil): Maximum recommended dose: 15 mg once daily.

* See Dosage and Administration in AHFS Essentials for additional information.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment: Adult

No dosage adjustment necessary.

Dosing: Hepatic Impairment: Adult

Hepatic impairment prior to initiation: No dosage adjustment necessary; use with caution if baseline liver tests are abnormal

Hepatic impairment during therapy: If liver injury is suspected (eg, fatigue, jaundice, dark urine): Interrupt therapy, measure serum liver tests, and investigate possible etiologies:

If an alternative etiology is not identified and ALT >3 x ULN: Do not reinitiate therapy.

If an alternative etiology is identified and ALT elevated (but <3 x ULN) or total bilirubin elevated (but <2 x ULN): May reinitiate with caution.

Use: Labeled Indications

Diabetes mellitus, type 2: As an adjunct to diet and exercise, to improve glycemic control in adults with type 2 diabetes mellitus

* See Uses in AHFS Essentials for additional information.

Class and Related Monographs

Thiazolidinediones (Glitazones)

Clinical Practice Guidelines

Diabetes Mellitus:

American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE), “Consensus Statement on the Comprehensive Type 2 Diabetes Management Algorithm - 2019 Executive Summary,” January 2019

American Diabetes Association, “Standards of Medical Care in Diabetes - 2019,” January 2019

American Diabetes Association and the European Association for the Study of Diabetes Consensus Report, “Management of Hyperglycemia in Type 2 Diabetes, 2018,” December 2018

Diabetes Canada, “Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada,” 2018

Administration: Oral

May be administered without regard to meals.

Dietary Considerations

Individualized medical nutrition therapy (MNT) is an integral part of therapy

Storage/Stability

Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from light, moisture, and humidity.

Medication Patient Education with HCAHPS Considerations

What is this drug used for?

• It is used to lower blood sugar in patients with high blood sugar (diabetes).

Frequently reported side effects of this drug

• Headache

• Common cold symptoms

• Sinus pain

• Sore throat

• Muscle pain

• Passing gas

Other side effects of this drug: Talk with your doctor right away if you have any of these signs of:

• Heart problems like cough or shortness of breath that is new or worse, swelling of the ankles or legs, abnormal heartbeat, weight gain of more than five pounds in 24 hours, dizziness, or passing out.

• Bone pain

• Severe loss of strength and energy

• Chest pain

• Vision changes

• Painful urination

• Blood in the urine

• Passing a lot of urine

• Low blood sugar like dizziness, headache, fatigue, feeling weak, shaking, fast heartbeat, confusion, increased hunger, or sweating.

• Liver problems like dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin.

• Signs of a significant reaction like wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Medication Safety Issues

Sound-alike/look-alike issues:

International issues:

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and at https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021073s049lbl.pdf#page=35, must be dispensed with this medication.

Contraindications

Hypersensitivity to pioglitazone or any component of the formulation; NYHA Class III/IV heart failure (initiation of therapy)

Canadian labeling: Additional contraindications (not is U.S. labeling): Any stage of heart failure (eg, NYHA Class I, II, III, IV); serious hepatic impairment; active bladder cancer; history of bladder cancer; uninvestigated macroscopic hematuria; pregnancy

Warnings/Precautions

Concerns related to adverse effects:

• Bladder cancer: An FDA review concluded that although clinical trial data are inconsistent regarding the risk of bladder cancer in patients exposed to pioglitazone, there is still the potential for an increased risk and package labeling has been updated to reflect this. Avoid use of pioglitazone in patients with active bladder cancer and consider risks versus benefits prior to initiating therapy in patients with a history of bladder cancer.

• Edema: Dose-related edema, including new-onset or exacerbation of existing edema, has been reported; use with caution in patients with edema. Monitor for signs/symptoms of heart failure.

• Fractures: An increased incidence of bone fractures in females treated with pioglitazone has been observed; majority of fractures occurred in the lower limb and distal upper limb. Consider risk of fracture prior to initiation and during use.

• Heart failure/cardiac effects: [US Boxed Warning]: Thiazolidinediones, including pioglitazone, may cause or exacerbate heart failure; closely monitor for signs and symptoms of heart failure (HF) (eg, rapid weight gain, dyspnea, edema), particularly after initiation or dose increases; if HF develops, treat accordingly and consider dose reduction or discontinuation of pioglitazone. Not recommended for use in any patient with symptomatic HF. Initiation of therapy is contraindicated in patients with NYHA class III or IV HF; if used in patients with NYHA class I or II (systolic) HF, initiate at lowest dosage and monitor closely.

• Hematologic effects: May decrease hemoglobin/hematocrit; effects may be related to increased plasma volume.

• Hepatic effects: Hepatic failure, including fatalities, has been reported. Monitor for signs/symptoms of liver injury closely during therapy; discontinuation of therapy may be necessary.

• Hypoglycemia: The risk of hypoglycemia is increased when pioglitazone is combined with insulin or other diabetic medications; dosage adjustment of concomitant hypoglycemic agents may be necessary.

• Macular edema: Has been reported with thiazolidinedione use, including pioglitazone; some patients with macular edema presented with blurred vision or decreased visual acuity, and most had peripheral edema at time of diagnosis. Patients should be seen by an ophthalmologist if any visual symptoms arise during therapy and all diabetic patients should have regular eye exams.

• Weight gain: Dose-related weight gain observed with use; mechanism unknown but likely associated with fluid retention and fat accumulation.

Disease-related concerns:

• Bariatric surgery:

– Altered absorption: Absorption may be altered given the anatomic and transit changes created by gastric bypass and sleeve gastrectomy surgery (Mechanick 2013; Melissas 2013).

– Weight gain: Evaluate risk vs benefit and consider alternative therapy after gastric bypass, sleeve gastrectomy, and gastric banding; weight gain may occur (Apovian 2015).

• Diabetes, type 1: Mechanism requires the presence of insulin; therefore, use in type 1 diabetes or diabetic ketoacidosis is not recommended.

• Hepatic impairment: Due to the possible risk of drug-induced liver injury, serum liver function tests (ALT, AST, alkaline phosphatase, and total bilirubin) should be obtained prior to initiation in all patients. In patients with abnormal hepatic tests, therapy should be initiated with caution. During therapy, if signs/symptoms of liver injury (eg, fatigue, anorexia, jaundice, dark urine, right upper abdominal discomfort) arise, interrupt pioglitazone therapy, obtain liver tests immediately and evaluate alternative etiologies. If an alternative etiology is not identified and serum ALT is >3 × ULN, do not resume therapy. Patients with serum ALT >3 × ULN and serum total bilirubin >2 × ULN are at risk for severe drug-induced liver injury.

Concurrent drug therapy issues:

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

* See Cautions in AHFS Essentials for additional information.

Geriatric Considerations

Intensive glucose control (HbA_1c <6.5%) has been linked to increased all-cause and cardiovascular mortality, hypoglycemia requiring assistance, and weight gain in adult type 2 diabetes. How "tightly" to control a geriatric patient's blood glucose needs to be individualized. Such a decision should be based on several factors, including the patient's functional and cognitive status, how well he/she recognizes hypoglycemic or hyperglycemic symptoms, and how to respond to them and other disease states. An HbA_1c <7.5% is an acceptable endpoint for a healthy older adult, while <8% to 8.5% is acceptable for elderly patients, depending on the level of comorbities, functional and cognitive status, and living situation (eg, caregiver present to assist, long-term care facility). For elderly patients with diabetes who are relatively healthy, attaining target goals for aspirin use, blood pressure, lipids, smoking cessation, and diet and exercise may be more important than normalized glycemic control (ADA 2018b). In elderly patients with heart failure, this medication is considered potentially inappropriate due to the potential to increase fluid retention and increase the risk of heart failure exacerbation. Avoid in elderly patients with symptomatic heart failure; use with caution in asymptomatic heart failure (Beers Criteria [AGS 2019]). Thiazolidinediones should be used with caution in the older adult at risk for falls or fractures because of the negative impact on bone structure by this class of agents (ADA 2018b; Kahn 2008).

Pregnancy Considerations

Information related to the use of pioglitazone in pregnancy is limited (Glueck 2003; Ortega-Gonzalez 2005; Ota 2008).

Poorly controlled diabetes during pregnancy can be associated with an increased risk of adverse maternal and fetal outcomes, including diabetic ketoacidosis, preeclampsia, spontaneous abortion, preterm delivery, delivery complications, major birth defects, stillbirth, and macrosomia. To prevent adverse outcomes, prior to conception and throughout pregnancy, maternal blood glucose and HbA_1c should be kept as close to target goals as possible but without causing significant hypoglycemia (ADA 2020; Blumer 2013).

Agents other than pioglitazone are currently recommended to treat diabetes mellitus in pregnancy (ADA 2020).

Thiazolidinediones may cause ovulation in anovulatory premenopausal females, increasing the risk of unintended pregnancy. Due to long-term safety concerns associated with their use, thiazolidinediones should be avoided in females of reproductive age (Fauser 2012).

Breast-Feeding Considerations

It is not known if pioglitazone is present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Lexicomp Pregnancy & Lactation, In-Depth

• Pioglitazone

Briggs' Drugs in Pregnancy & Lactation

• Pioglitazone

Adverse Reactions

Adverse reactions and incidences reported are associated with monotherapy unless otherwise stated.

>10%:

Cardiovascular: Edema (combination trials: ≤27%)

Endocrine and metabolic: Hypoglycemia (combination trials: ≤27%)

Respiratory: Upper respiratory tract infection (13%)

1% to 10%:

Cardiovascular: Cardiac failure (combination trials: ≤8%)

Central nervous system: Headache (9%)

Neuromuscular & skeletal: Bone fracture (females: ≤5%), myalgia (5%)

Respiratory: Sinusitis (6%), pharyngitis (5%)

Frequency not defined:

Endocrine & metabolic: Decreased serum triglycerides, increased HDL-cholesterol, weight gain, weight loss

Hematologic & oncologic: Decreased hematocrit, decreased hemoglobin

<1%, postmarketing, and/or case reports: Bladder carcinoma, blurred vision, decreased visual acuity, dyspnea (associated with weight gain and/or edema), hepatic failure (very rare), hepatitis, increased creatine phosphokinase, increased serum transaminases, macular edema (new-onset or worsening), pulmonary edema, rhabdomyolysis

* See Cautions in AHFS Essentials for additional information.

Allergy and Idiosyncratic Reactions

• Thiazolidinedione Allergy

Metabolism/Transport Effects

Substrate of CYP2C8 (major), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions Open Interactions

Alpha-Lipoic Acid: May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Androgens: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Exceptions: Danazol. Risk C: Monitor therapy

CYP2C8 Inducers (Moderate): May decrease the serum concentration of Pioglitazone. Risk C: Monitor therapy

CYP2C8 Inhibitors (Moderate): May increase the serum concentration of Pioglitazone. Risk C: Monitor therapy

CYP2C8 Inhibitors (Strong): May increase the serum concentration of Pioglitazone. Management: Limit the pioglitazone dose to 15 mg daily and monitor for increased pioglitazone toxicities (eg, hypoglycemia) when used in combination with strong CYP2C8 inhibitors. Risk D: Consider therapy modification

Direct Acting Antiviral Agents (HCV): May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Guanethidine: May enhance the hypoglycemic effect of Antidiabetic Agents. Risk C: Monitor therapy

Hyperglycemia-Associated Agents: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Hypoglycemia-Associated Agents: Antidiabetic Agents may enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Risk C: Monitor therapy

Insulins: Pioglitazone may enhance the adverse/toxic effect of Insulins. Specifically, the risk for hypoglycemia, fluid retention, and heart failure may be increased with this combination. Management: If insulin is combined with pioglitazone, dose reductions should be considered to reduce the risk of hypoglycemia. Monitor patients for fluid retention and signs/symptoms of heart failure. Risk D: Consider therapy modification

Lumacaftor and Ivacaftor: May decrease the serum concentration of CYP2C8 Substrates (High Risk with Inhibitors or Inducers). Lumacaftor and Ivacaftor may increase the serum concentration of CYP2C8 Substrates (High Risk with Inhibitors or Inducers). Risk C: Monitor therapy

Maitake: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Monoamine Oxidase Inhibitors: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Pegvisomant: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Pregabalin: May enhance the fluid-retaining effect of Thiazolidinediones. Risk C: Monitor therapy

Prothionamide: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Quinolones: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Quinolones may diminish the therapeutic effect of Agents with Blood Glucose Lowering Effects. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Risk C: Monitor therapy

Ritodrine: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Salicylates: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Selective Serotonin Reuptake Inhibitors: May enhance the hypoglycemic effect of Agents with Blood Glucose Lowering Effects. Risk C: Monitor therapy

Sulfonylureas: Thiazolidinediones may enhance the hypoglycemic effect of Sulfonylureas. Management: Consider sulfonylurea dose adjustments in patients taking thiazolidinediones and monitor for hypoglycemia. Risk D: Consider therapy modification

Thiazide and Thiazide-Like Diuretics: May diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Topiramate: May decrease the serum concentration of Pioglitazone. Risk C: Monitor therapy

Genes of Interest

• Cytochrome P450 2C8

Monitoring Parameters

Hemoglobin A_1c (at least twice yearly in patients who have stable glycemic control and are meeting treatment goals; quarterly in patients not meeting treatment goals or with therapy change [ADA 2019]), serum glucose.

Liver enzymes (ALT, AST, alkaline phosphatase, and total bilirubin) prior to initiation in all patients (with or without liver disease); continue routine periodic monitoring during treatment only in patients with liver disease or suspected liver disease.

Signs and symptoms of fluid retention or heart failure; weight gain; signs/symptoms of bladder cancer (dysuria, macroscopic hematuria, dysuria, urinary urgency); ophthalmic exams

Reference Range

Recommendations for glycemic control in nonpregnant adults with diabetes (ADA 2019):

HbA_1c: <7% (a more aggressive [<6.5%] or less aggressive [<8%] HbA_1c goal may be targeted based on patient-specific characteristics)

Preprandial capillary blood glucose: 80 to 130 mg/dL (more or less stringent goals may be appropriate based on patient-specific characteristics)

Peak postprandial capillary blood glucose: <180 mg/dL (more or less stringent goals may be appropriate based on patient-specific characteristics)

Recommendations for glycemic control in older adults (≥65 years) with diabetes (ADA 2019):

HbA_1c: <7.5% (healthy); <8% (complex/intermediate health); <8.5% (very complex/poor health) (individualization may be appropriate based on patient and caregiver preferences)

Preprandial capillary blood glucose: 90 to 130 mg/dL (healthy); 90 to 150 mg/dL (complex/intermediate health); 100 to 180 mg/dL (very complex/poor health)

Bedtime capillary blood glucose: 90 to 150 mg/dL (healthy); 100 to 180 mg/dL (complex/intermediate health); 110 to 200 mg/dL (very complex/poor health)

Advanced Practitioners Physical Assessment/Monitoring

Monitor for signs of heart failure (weight gain, edema, dyspnea). Teach risks of hyperglycemia. Refer patient to a diabetic educator, if available.

Nursing Physical Assessment/Monitoring

Monitor for signs of heart failure (weight gain, edema, dyspnea). Teach risks of hyperglycemia. Refer patient to a diabetic educator, if available.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral:

Actos: 15 mg, 30 mg, 45 mg

Generic: 15 mg, 30 mg, 45 mg

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Tablet, Oral:

Actos: 15 mg [DSC], 30 mg [DSC], 45 mg [DSC]

Generic: 15 mg, 30 mg, 45 mg

Anatomic Therapeutic Chemical (ATC) Classification

• A10BG03

Generic Available (US)

Yes

Pricing: US

Tablets (Actos Oral)

15 mg (per each): $15.54

30 mg (per each): $23.75

45 mg (per each): $25.76

Tablets (Pioglitazone HCl Oral)

15 mg (per each): $0.07 - $7.01

30 mg (per each): $0.10 - $10.72

45 mg (per each): $0.11 - $11.63

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Mechanism of Action

Thiazolidinedione antidiabetic agent that lowers blood glucose by improving target cell response to insulin, without increasing pancreatic insulin secretion. It has a mechanism of action that is dependent on the presence of insulin for activity. Pioglitazone is a potent and selective agonist for peroxisome proliferator-activated receptor-gamma (PPARgamma). Activation of nuclear PPARgamma receptors influences the production of a number of gene products involved in glucose and lipid metabolism. PPARgamma is abundant in the cells within the renal collecting tubules; fluid retention results from stimulation by thiazolidinediones which increases sodium reabsorption.

Pharmacodynamics/Kinetics

Onset of action: Delayed

Peak effect: Glucose control: Several weeks

Distribution: V_d (apparent): 0.63 ± 0.41 L/kg

Protein binding: Pioglitazone >99% and active metabolites >98%; primarily to albumin

Metabolism: Hepatic (99%) via CYP2C8 and 3A4 to active and inactive metabolites; M-III and M-IV are major circulating active metabolites

Half-life elimination: Parent drug: 3 to 7 hours; M-III and M-IV metabolites: 16 to 24 hours

Time to peak: ~2 hours; delayed with food

Excretion: Urine (15% to 30%) and feces as metabolites

Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Pioglitazone-dependent diabetics should be appointed for dental treatment in morning in order to minimize chance of stress-induced hypoglycemia.

Effects on Bleeding

No information available to require special precautions

Related Information

• Beers Criteria 2019: Potentially Inappropriate Medication Use in Older Adults ≥65 Years of Age
• Oral Antidiabetic Agents Comparison Table

Index Terms

Pioglitazone HCl

FDA Approval Date

July 15, 1999

References

2019 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019;67(4):674-694. doi: 10.1111/jgs.15767.[PubMed 30693946]

Actos (pioglitazone) [prescribing information]. Deerfield, IL: Takeda Pharmaceuticals America Inc; December 2017.

Actos (pioglitazone) [product monograph]. Oakville, Ontario, Canada: Takeda Canada Inc; January 2018.

American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 201: Pregestational diabetes mellitus. Obstet Gynecol. 2018;132(6):e228-e248. doi: 10.1097/AOG.0000000000002960.[PubMed 30461693]

American Diabetes Association (ADA). Diabetes Care. 2019;42(suppl 1):S1-S193. http://care.diabetesjournals.org/content/42/Supplement_1. Accessed January 10, 2019.[PubMed 29222377]

American Diabetes Association (ADA). Standards of medical care in diabetes–2020. Diabetes Care. 2020;43(suppl 1):S1-S212. https://care.diabetesjournals.org/content/43/Supplement_1. Accessed January 22, 2020.

Apovian CM, Aronne LJ, Bessesen DH, et al; Endocrine Society. Pharmacological management of obesity: an Endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2015;100(5):2135-2136]. J Clin Endocrinol Metab. 2015;100(2):342-362. doi: 10.1210/jc.2014-3415[PubMed 25590212]

Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227-4249.[PubMed 24194617 ]

Fauser BC, Tarlatzis BC, Rebar RW, et al. Consensus on women's health aspects of polycystic ovary syndrome (PCOS): The Amsterdam ESHRE/ASRM-sponsored 3rd PCOS consensus workshop group. Fertil Steril. 2012;97(1):28-38.[PubMed 22153789]

Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive type 2 diabetes management algorithm - 2019 executive summary. Endocr Pract. 2019;25(1):69-100. doi: 10.4158/CS-2018-0535. Erratum in: Endocr Pract. 2019;25(2):204.[PubMed 30742570]

Glueck CJ, Moreira A, Goldenberg N, et al, "Pioglitazone and Metformin in Obese Women With Polycystic Ovary Syndrome Not Optimally Responsive to Metformin," Hum Reprod, 2003, 18(8):1618-25.[PubMed 12871871]

Jamp-Pioglitazone (pioglitazone hydrochloride USP) [product monograph]. Boucherville, Quebec, Canada: Jamp Pharma Corporation; March 2019.

Kirkman M, Briscoe VJ, Clark N, et al, "Diabetes in Older Adults: A Consensus Report," J Am Geriatr Soc, 2012; doi: 10.1111/jgs.12035.[PubMed 23106132]

Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159-191. doi: 10.1016/j.soard.2012.12.010.[PubMed 23537696]

Melissas J, Leventi A, Klinaki I, et al. Alterations of global gastrointestinal motility after sleeve gastrectomy: a prospective study. Ann Surg. 2013;258(6):976-982. doi: 10.1097/SLA.0b013e3182774522.[PubMed 23160151]

Ortega-Gonzalez C, Cardoza L, Coutino B, et al, "Insulin Sensitizing Drugs Increase the Endogenous Dopaminergic Tone in Obese Insulin-Resistant Women With Polycystic Ovary Syndrome," J Endocrinol, 2005, 184(1):233-9.[PubMed 15642799]

Ota H, Goto T, Yoshioka T, et al, "Successful Pregnancies Treated With Pioglitazone in Infertile Patients With Polycystic Ovary Syndrome," Fertil Steril, 2008, 90(3):709-13.[PubMed 18423625]

Practice Committee of American Society for Reproductive Medicine, "Use of Insulin-Sensitizing Agents in the Treatment of Polycystic Ovary Syndrome," Fertil Steril, 2008, 90(5 Suppl):S69-73.[PubMed 19007650]

Brand Names: International

Accotaz (CR, DO, GT, HN, NI, PA, SV); Acpio (AU); Acstin (KR); Actos (AE, AR, AT, AU, BB, BE, BG, BH, BM, BO, BR, BS, BZ, CH, CL, CN, CO, CZ, DE, DK, EE, EG, ES, FI, FR, GB, GR, GY, HK, HR, HU, ID, IE, IL, IT, JM, JO, JP, KR, KW, LB, LT, LU, LV, MT, MY, NL, NO, NZ, PE, PH, PL, PR, PT, QA, RO, RU, SA, SE, SG, SI, SK, SR, TH, TR, TT, TW, VE); Actozon (KR); Actozone (EG); Anxotos (TW); Apogar (MX); Cereluc (AR); Chronoreg (EG); Deculin (ID); Diabetin (EG); Diabetone (PH); Diaglit (BD); DMZone (KR); Gitazone (TH); Glacera (BH); Glezone (KR); Gliabetes (ID); Glidipion (BE, IE, RO); Gliozac (MX); Glita (IN); Glitaz (ET, PH); Glitis (TW); Glito (LK, VN); Glitter (PH); Glizone (KR); Glubosil (TH); Glucemin (CO); Gluconon (KR); Glustin (AE, AT, BE, BF, BG, BH, BJ, CH, CI, CY, CZ, DE, DK, EE, ES, ET, FI, FR, GB, GH, GM, GN, GR, HN, HU, IE, IL, IQ, IR, IT, KE, LB, LR, LT, LY, MA, ML, MR, MT, MU, MW, NE, NG, NL, NO, OM, PT, RU, SA, SC, SD, SE, SK, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM, ZW); Glutason (UA); Insulact (PH); Insulact Forte (PH); Kai Bao Wei Yuan (CN); Lispecip (RO); Newpio (KR); Nilgar (VN); Ogli (BD); Paglitaz (IE); Pidus (BD); Pio (HR); Pioglit (IN, PY); Pioglite (VN); Piolidone (KR); Piomed (UY); Piomin (KR); Pionix (ID); Piorance (PH); Piosafe 15 (TZ); Piosugar (TW); Piota (TW); Piouno (PH); Piozer (LK); Piozon (BD); Piozone (TH); Pizaccord (AU); Politone (TW); Ppar (PH); Prabetic (ID); Prialta (PH); Protaz (ID); Relexil (MX); Senzulin (TH); Uniglit (JO); Utmos (TH); Vexazone (AU); Zactos (MX); Zacts (CR, DO, GT, HN, NI, PA, SV); Zolid (PK)

Last Updated 2/20/20