Experiences with
Pioglitazone

Pioglitazone is a medicine used to treat type 2 diabetes.

Type 2 diabetes is a condition where the body does not make enough insulin, or the insulin that it makes does not work properly. This can cause high blood sugar levels (hyperglycaemia).

Pioglitazone helps to control your blood sugar levels by helping your body make better use of the insulin it produces.

Pioglitazone is only available on prescription. It comes as tablets.

It also comes as tablets containing a mixture of pioglitazone and another diabetes medicine called metformin. This is known by the brand name Competact.

Who can take pioglitazone

Most adults aged 18 and over can take pioglitazone.

Who may not be able to take pioglitazone

Pioglitazone is not suitable for some people. To make sure it's safe for you, tell your doctor if you:

have ever had an allergic reaction to pioglitazone or any other medicine
have liver or heart problems
have ever had bladder cancer or blood in your pee
have conditions caused by your diabetes, including macular oedema (a swelling at the back of your eye)
have a condition such as osteoporosis or osteopenia that affects your bones

If you're over 65, you may be more likely to break a bone or get heart failure. Talk to your doctor about whether pioglitazone is suitable for you.

Dosage and strength

Pioglitazone comes as 15mg, 30mg and 45mg tablets.

The usual starting dose is 1 tablet (either 15mg or 30mg), taken once a day. The maximum dose is 45mg, taken once a day.

Changes to your dose

Your doctor will check your blood sugar levels regularly. They may change your dose of pioglitazone if they need to.

How to take it

You can take pioglitazone at any time, for example in the morning or in the evening. Try to take it at the same time every day.

Swallow the tablet whole with a drink of water. Do not chew it.

You can take pioglitazone with or without food.

How long to take it for

Treatment for diabetes is usually for life.

Do not stop taking pioglitazone without talking to your doctor. If you stop taking pioglitazone suddenly, your blood sugar levels may get worse.

If you want to stop taking your medicine, speak to your doctor. They may be able to suggest an alternative treatment for your diabetes.

If you forget to take it

If you forget to take your pioglitazone, skip the missed dose and take your next dose at the usual time.

Do not take 2 doses to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to remember to take your medicines.

If you take too much

The amount of pioglitazone that can lead to an overdose varies from person to person.

If you take pioglitazone with other diabetes medicines, taking too many tablets may cause low blood sugar.

If you think you have low blood sugar, have some food or drink that quickly gets sugar into your bloodstream such as sugar cubes or fruit juice. This type of sugar will not last long in your blood, so you may also need to eat a starchy carbohydrate, like a sandwich or some biscuits.

you take more than your prescribed dose of pioglitazone

Go to 111.nhs.uk or call 111

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the pioglitazone packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Common side effects

These common side effects of pioglitazone happen in more than 1 in 100 people. There are things you can do to help cope with them:

Make sure you get your yearly flu vaccine. If you're getting a lot of infections, or you're worried, speak to your doctor.

Your eyesight may be affected for a short time at the start of your treatment. Do not drive, cycle or use machinery until your eyesight is back to normal. If it lasts for more than a day or two, make an appointment with your doctor.

Try to eat a healthy balanced diet without increasing your portion sizes. Regular exercise will also help to keep your weight stable. If you're still putting on weight see your doctor – it may be due to fluid retention.

If pins and needles bothers you or does not go away after a few days, talk to your doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Some people may have serious side effects after taking pioglitazone.

Call your doctor or call 111 now if:

the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – these can be signs of a liver problem
you put on weight quickly, your arms, legs or stomach are swollen, and you have problems breathing – these can be signs of heart failure
there's blood in your pee and you have problems peeing or need to pee urgently – these can be signs of bladder cancer

You're also at greater risk of breaking a bone when taking pioglitazone, particularly if you are a woman. If you're treated for a broken bone or fracture, let your doctor know as soon as possible afterwards.

Low blood sugar

Pioglitazone does not usually cause low blood sugar (known as hypoglycaemia, or "hypos") when taken on its own.

But hypos can happen when you take pioglitazone with other diabetes medicines such as insulin or gliclazide.

Early warning signs of low blood sugar include:

feeling hungry
trembling or shaking
sweating
confusion
difficulty concentrating

It's also possible for your blood sugar to go too low while you're asleep. If this happens, it can make you feel sweaty, tired and confused when you wake up.

Low blood sugar may happen if you:

take too much of some types of diabetes medicines
do not eat meals regularly, or skip meals
are fasting
do not eat a healthy diet and are not getting enough nutrients
change what you eat
increase your physical activity without eating more to compensate
drink alcohol, especially after skipping a meal
take some other medicines or herbal remedies at the same time
have a hormone disorder such as an underactive thyroid (hypothyroidism)
have kidney or liver problems

To prevent hypos, it's important to have regular meals, including breakfast. Never miss or delay a meal.

If you're planning to exercise more than usual, make sure you eat carbohydrates like bread, pasta or cereals before, during or after exercise.

Always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help.

You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

If taking in sugar does not help or if the hypo symptoms come back, contact your doctor or the nearest hospital.

Make sure your friends and family know about your diabetes and the symptoms of low blood sugar levels so they can recognise a hypo if it happens.

Serious allergic reaction

It's possible to have a serious allergic reaction (anaphylaxis) to pioglitazone.

Meds New IA (H4) - serious allergic reaction

Pioglitazone is usually safe to take for a long time. Your doctor will give you regular tests to check whether it's OK for you to continue taking it.

If you're over 65 you're slightly more likely to get some side effects of pioglitazone, such as heart failure.

Other side effects

These are not all the side effects of pioglitazone. For a full list see the leaflet inside your medicines packet.

Pioglitazone and pregnancy

Pioglitazone is not recommended in pregnancy as there is not much information about its safety during pregnancy.

Other medicines used to treat diabetes, such as insulin and metformin, are safe to take while pregnant.

If you are pregnant or thinking of getting pregnant, talk to your doctor as they will need to review your treatment. They will be able to suggest a different medicine that is safer for you to take in pregnancy.

Pioglitazone and breastfeeding

Pioglitazone is not usually recommended while breastfeeding. We do not know how much pioglitazone passes into breast milk, but it is possible it could lower your baby's blood sugar level.

If you are breastfeeding, or planning to breastfeed, talk to your doctor about what's best for you and your baby. They will need to review your treatment and may be able to suggest a different medicine for you, particularly if you're breastfeeding a newborn or premature baby.

If your doctor says it's OK to keep taking it while breastfeeding, contact your health visitor, midwife, pharmacist or doctor as soon as possible if your baby:

is not feeding as well as usual or seems hungrier
seems unusually sleepy or irritable
is paler or more sweaty than usual
is peeing more
is causing you any other concerns

Pioglitazone and fertility

There's no evidence to suggest that taking pioglitazone reduces fertility in either men or women.

Speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.

Meds New IA (H2) - Pregnancy non-urgent care card

Cautions with other medicines

Some medicines affect the way pioglitazone works. Your doctor may need to adjust your dose of pioglitazone. They may also recommend checking your blood sugar levels more often.

Tell your doctor if you're taking any of these medicines before starting to take pioglitazone:

gemfibrozil, a medicine used to reduce cholesterol
rifampicin, an antibiotic used to treat tuberculosis (TB)

Taking pioglitazone with painkillers

It's safe to take paracetamol with pioglitazone.

Check with your doctor or pharmacist before taking ibuprofen with pioglitazone. This is particularly important if you have heart problems or if you're at risk of getting heart problems.

Mixing pioglitazone with herbal remedies and supplements

There's not enough information to say that herbal remedies or supplements are safe to take with pioglitazone. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

Meds New IA (H2) - Cautions with other medicines alert