Pioglitazone
- Class: Thiazolidinedione
- Used for: type 2 diabetes
- Say it: pye-oh-GLIT-uh-zohn
- Forms: tablet
PIOGLITAZONE PILES IT ON — fluid first, then weight. Which is why it is barred in heart failure.
Activating PPAR-gamma increases renal sodium reabsorption, expanding plasma volume. In a heart with no reserve that extra volume is enough to tip it into overt failure.
It activates PPAR-gamma in fat cells, changing which genes are expressed and improving insulin sensitivity. Because it adds no insulin of its own, it causes no hypoglycaemia — but gene changes take weeks to show.
Side effects
Common: weight gain, fluid retention, ankle swelling
Serious: heart failure, bone fractures
Typical dose
15–45 mg once daily
Start at 15 mg. It acts on gene expression, so allow 8 to 12 weeks before judging the dose.
Check yourself
Why is pioglitazone contraindicated in heart failure?
- It causes renal sodium and fluid retention that can precipitate decompensation
- It slows the heart rate dangerously
- It causes severe hypoglycaemia in these patients
- It interacts with every diuretic
Show answer
A. It causes renal sodium and fluid retention that can precipitate decompensation
PPAR-gamma activation increases sodium reabsorption in the kidney, expanding plasma volume. In a heart with no reserve, that extra volume is enough to tip a compensated patient into overt failure.
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