Pioglitazone monotherapy

Pioglitazone monotherapy is effective in type 2 diabetes. In a study of 408 patients, pioglitazone reduced HbAlc in a dose-dependent fashion [17],... 

Commonly referred to as TZDs or glitazones, thiazolidine-diones have established a significant role in type 2 DM therapy. As monotherapy, both rosiglitazone and pioglitazone reduce... 

When given for about 6 months, pioglitazone and rosiglitazone reduce A1C values by about 1.5% and FPG levels by about 60 to 70 mg/dL at maximal doses. Maximal glycemic-lowering effects may not be seen until 3 to 4 months of therapy. Monotherapy is often ineffective unless the drugs... 

Monotherapy - Initiate monotherapy in patients not adequately controlled with diet and exercise at 15 or 30 mg once daily. For patients who respond inadequately to the initial dose of pioglitazone, the dose can be increased in increments up to 45 mg once daily. Consider combination therapy for patients not responding adequately to monotherapy. 

Lipids - Rosiglitazone as monotherapy was associated with increases in total cholesterol, LDL, and HDL and decreases in free fatty acids. Patients treated with pioglitazone had mean decreases in triglycerides, mean increases in HDL cholesterol. 

Starting dose for patients inadequately controlled on metformin monotherapy -Based on the usual starting dose of pioglitazone (15 to 30 mg daily), pioglitazone/metformin may be initiated at either the 15 mg/500 mg or 15 mg/850 mg tablet strength once or twice daily, and gradually titrated after assessing adequacy of therapeutic response. 

Pioglitazone is approved for use as monotherapy and in conjunction with metformin, sulfonylureas, and insulin. It is taken once a day with or without food. Though pioglitazone may also cause a small increase in low-density lipoprotein concentrations, there is usually a modest decrease in triglyceride levels, but it unclear whether this has any clinical significance or persists in the long term. 

Pioglitazone also causes fluid retention, possibly because of increased production of vascular endothelial growth factor (92). The safety profile of monotherapy and combined therapy with pioglitazone has been evaluated in 3500 patients over 2500 patient-years, and some data from post-marketing surveillance were included peripheral edema and hemodilution were common (93). 

Aronoff S, Rosenblatt S, Braithwaite S, Egan JW, Mathisen AL, Schneider RLThe Pioglitazone 001 Study Group. Pioglitazone hydrochloride monotherapy improves glycemic control in the treatment of patients with type 2 diabetes a 6-month randomized placebo-controlled dose-response study. Diabetes Care 2000 23(11) 1605-11. 

The US FDA has approved pioglitazone and rosiglitazone for use as monotherapy for type 2 diabetes or in combination with metformin, sulfonylureas, or insulin. 

Although the incidence of heart failure with pioglitazone or rosighatoze monotherapy is low, <1%, the American Heart Association and American Diabetes Association have a joint consensus statement regarding the use of TZD in patients with cardiovascular disease. They recommend TZDs to be used cautiously and initiated at low doses in patients with class I or n NYHA category heart failure, and they are not recommended in class m or IV heart failure. 

Metabolism Hypoglycaemia Amulticenter, randomised, double-blind, placebo-controlled, parallel-arm study compared pioglitazone 15, 30, or 45 mg alone or in combination with alogliptin 12.5 or 25 mg in 1554 patients on stable-dose metformin monotherapy (>1500 mg) with inadequate glycaemic control for 26-weeks. Hypoglycaemia was less... 

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