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Tuesday, February 8, 2011

pioglitazone

Posted by Sampil 11:56 PM, under | No comments

pioglitazone
(pie oh glit' ah zohn)
Actos

Pregnancy Category C

Drug classes
Antidiabetic
Thiazolidinedione

Therapeutic actions
Resensitizes tissues to insulin; stimulates insulin receptor sites to lower blood glucose and improve the action of insulin; decreases hepatic gluconeogenesis and increases insulin-dependent muscle glucose uptake.

Indications
·        Monotherapy as an adjunct to diet and exercise to improve glucose control in patients with type 2 (non–insulin-dependent) diabetes
·        As part of combination with a sulfonylurea, metformin, or insulin when diet, exercise plus a single agent alone does not result in adequate glycemic control in type 2 diabetes

Contraindications and cautions
·        Contraindicated with allergy to any thiazolidinedione; type 1 (insulin-dependent) diabetes, ketoacidosis, lactation.
·        Use cautiously with advanced heart disease, liver failure, pregnancy.

Available forms
Tablets—15, 30, 45 mg

Dosages
ADULTS
15–30 mg daily as a single oral dose; if adequate response is not seen, dosage may be increased to a maximum 45 mg daily PO.
·        Combination therapy with sulfonylurea or metformin: 15–30 mg daily PO added to the established dose of the other agent; if hypoglycemia occurs, reduce the dose of the other agent.
·        Combination therapy with insulin: Initiate pioglitazone at 15 or 30 mg while maintaining insulin dose. Decrease insulin dose by 10%–25% if hypoglycemic or if glucose < 100 mg/dL.
PEDIATRIC PATIENTS
Safety and efficacy not established.
PATIENTS WITH HEPATIC IMPAIRMENT
Use caution and monitor patient closely. Do not administer if AST > 2.5 times the upper level of normal.

Pharmacokinetics
Route
Onset
Peak
Oral
Rapid
2–4 hr

Metabolism: Hepatic; T1/2: 3–7 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Feces, urine

Adverse effects
·        CNS: Headache, pain, myalgia
·        CV: Fluid retention
·        Endocrine: Hypoglycemia, hyperglycemia, aggravated diabetes
·        GI: Diarrhea, liver injury
·        Respiratory: Sinusitis, URI, rhinitis
·        Other: Infections, fatigue, tooth disorders

Interactions
·        Decreased effectiveness of hormonal contraceptives, which may result in ovulation and risk of pregnancy; suggest the use of an alternative method of birth control or consider a higher dose of the contraceptive
·        Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery

Nursing considerations
CLINICAL ALERT!

Assessment
·        History: Allergy to any thiazolidinedione; type 1 diabetes, ketoacidosis, serious hepatic impairment, advanced heart disease, pregnancy, lactation
·        Physical: T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation; LFTs, blood glucose, CBC

Interventions
·        Monitor urine or blood glucose levels frequently to determine effectiveness of drug and dosage being used.
·        Monitor baseline LFTs before beginning therapy and periodically during therapy.
·        Administer without regard to meals.
·        Arrange for consultation with dietitian to establish weight loss program and dietary control as appropriate.
·        Arrange for thorough diabetic teaching program to include disease, dietary control, exercise, signs and symptoms of hypoglycemia and hyperglycemia, avoidance of infection, hygiene.

Teaching points
·        Do not discontinue this medication without consulting health care provider; continue with diet and exercise program for diabetes control.
·        Take this drug with meals. If dose is missed, it may be taken at the next meal. If dose is missed for an entire day, do not double dose the next day.
·        Monitor urine or blood for glucose and ketones as prescribed while adjusting to drug.
·        Use barrier contraceptives if currently taking hormonal contraceptives; these drugs may be ineffective if combined with pioglitazone.
·        Report fever, sore throat, unusual bleeding or bruising, rash, dark urine, light-colored stools, hypoglycemic or hyperglycemic reactions.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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