“Pioglitazone, is it banned Anti-Diabetic medication?”

Pioglitazone is a diabetes drug (thiazolidinedione – type, also called “glitazones”) used along with a proper diet and exercise program to control high blood sugar in patients with type 2 diabetes. It works by helping to restore body’s proper response to insulin, thereby lowering your blood sugar.

Thiazolidinediones, such as pioglitazone, are synthetic ligands for peroxisome proliferator-activated receptors (PPARs). They alter the transcription of genes influencing carbohydrate and lipid metabolism, resulting in changed amounts of protein synthesis and, therefore, metabolic changes. Pioglitazone improves glycaemic control in people with Type 2 diabetes by improving insulin sensitivity through its action at PPAR gamma 1 and PPAR gamma 2, and affects lipid metabolism through action at PPAR alpha. The results of these interactions include increases in glucose transporters 1 and 4, lowered free fatty acids, enhanced insulin signalling, reduced tumour necrosis factor alpha (TNF alpha) and remodelling of adipose tissue. Together, these can increase glucose uptake and utilisation in the peripheral organs and decrease gluconeogenesis in the liver, thereby reducing insulin resistance.

  1. Metformin and Pioglitazone are insulin sensitizers which improve insulin action or reduce insulin resistance.
  2. There is U.S. Food & Drug Administration black box warning about Congestive cardiac failure associated with Pioglitazone use. Also association with fluid retention (edema), bone fractures, bladder cancer.
  3. In Bangladesh, Drug Control Committee of Drug Administration (DGDA) cancel registration of Pioglitazone 30 mg and 45 mg at its 244th meeting on July 7, 2015 exempting Pioglitazone 15 mg with no further statement on this. At now, only Pioglitazone available as Tab. Lit (15 mg) as only brand name.
  4. Indian drug regulatory authority ban pioglitazone in June 2013 but then revoked the ban on July 31, 2013 due to lack of sufficient evidence and recommendation by the Drug Technical Advisory Board (DTAB).
  5. Regarding liver effect, ADA stated beneficial effect of Pioglitazone on NASH also.
  6. In my clinical practice, I am using Pioglitazone in very few selected cases like young girl of lean PCOS or early Diabetes with NASH with metformin intolerance.
  7. Judicious selection of patient with consideration of risk benefit ratio and counselling of patients is very important to prescribe Pioglitazone.

Dr. M Saifuddin
MBBS (DMC, K-56)
FCPS (Med), MD (Endo), FRCP (Ireland)
Assistant professor (Endocrinology)
Dhaka Medical College &
Author, FAQs in Diabetes, Endocrinology and Metabolism

Platform academic / Ariful Islam Neloy

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