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May be used as 3rd – 4th line agent in type 2 diabetes as will not cause hypoglycaemia
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Likely reduces cardiovascular disease independently of glycaemic control
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Useful agent in insulin resistance, obesity and fatty liver disease with greater effects in women
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Reduces insulin resistance and gluconeogenesis by activating the peroxisome proliferator-activated receptors gamma (PPAR-γ) and alpha (PPAR-α)
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Adverse effects of pioglitazone include:
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Weight gain (2-3 kg on average and predominantly fluid)
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Oedema
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Decreased bone mineral density and increased risk of fractures
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Pioglitazone should not be used in:
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Children (< 18 years), pregnancy and breastfeeding
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Type 1 diabetes
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Oedematous conditions e.g. macular oedema, heart failure, renal failure, liver failure etc.
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Osteoporosis or high risk of osteoporosis e.g. postmenopausal women, hypogonadal men
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Previous history of bladder cancer
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Start at 15 mg daily and can increase by 15 mg per month to maximum of 45 mg per day as required
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Each dose change takes 6 – 8 weeks to reach full effects
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If introduced to a regimen with insulin and/or sulfonylureas, then the dose of insulin and/or sulfonylureas may need to be reduced to prevent hypoglycaemia (particularly if the HbA1c is < 64 mmol/mol)