The drug atlas
Endocrine & Metabolic/Thiazolidinedione
Pioglitazone
also: glitazone · TZD · PPAR-gamma
Overview
An oral T2DM agent — insulin sensitiser with no hypoglycaemia, but weight gain and fluid retention limit it (avoid in heart failure).
Mechanism
Agonist at PPAR-γ nuclear receptors in adipocytes → ↑adipogenesis and fatty-acid uptake → ↑peripheral insulin sensitivity. No effect on insulin secretion → no hypoglycaemia alone.
Indications
- Type 2 diabetes (add-on, esp. if hypoglycaemia must be avoided)
Adverse effects
Fluid retention / worsening heart failureserious
Avoid in HF — the key contraindication.
Weight gainclassic
Fracture risk (↑distal limb fractures)common
Bladder cancer (small ↑) + hepatotoxicityserious
Avoid with active bladder cancer/haematuria; monitor LFTs.
Cautions & contraindications
Heart failure / history of HFall
Fluid retention.
Active or past bladder cancer, unexplained haematuriaall
Hepatic impairment, DKAall
Interactions
- Additive fluid retention with insulin (avoid combination in HF risk)
Monitoring & kinetics
Weight, oedema/HF signs; LFTs; glucose
Oral OD. No hypoglycaemia, weight-neutral on glucose but causes weight gain via fat/fluid.
Choosing it
true
Source: NICE NG28 — T2DM · BNF — Pioglitazone