Pioglar

Pioglar (pioglitazone) is a medicine that belongs to a class of medicines called thiazolidinediones. It is used to treat type 2 diabetes mellitus. Pioglitazone helps improve insulin sensitivity in those who have diabetes due to insulin resistance (when the body's cells stop responding to insulin) or insufficient insulin production.

Pioglitazone works by binding to certain proteins in the body's cells called PPAR-gamma receptors. This stimulates these receptors, improving insulin sensitivity, which helps control blood sugar levels.

Pioglitazone is usually taken along with diet and exercise to control blood sugar in patients with type 2 diabetes. It can be used as monotherapy or in combination with other antidiabetic drugs such as metformin or sulfonylureas.

It is important to note that pioglitazone may have side effects including weight gain, edema, increased blood fat levels, hypoglycemia (low blood sugar), and increased risk of cardiovascular events. Therefore, the use of pioglitazone should be supervised by a physician and adhere to dosage and use recommendations.

Indications Pioglara

1. Type 2 Diabetes Mellitus: Pioglitazone is used as a medicine to lower blood sugar levels in patients with type 2 diabetes. It is particularly effective in patients in whom insulin resistance (reduced sensitivity of tissues to the action of insulin) plays a key role in the development of diabetes.
2. Combination therapy: Pioglitazone may be used in combination with other antihyperglycemic agents such as metformin, sulfonylureas, or alpha-glucosidase inhibitors when monotherapy does not achieve adequate blood sugar control.
3. Preventing diabetic complications: Some studies suggest that pioglitazone may help prevent or slow the progression of diabetic complications such as diabetic nephropathy (kidney damage), diabetic retinopathy (retinal damage), and diabetic neuropathy (nerve damage).
4. Polycystic Ovarian Syndrome: Pioglitazone can be used to treat polycystic ovarian syndrome in women, which can help improve menstrual cycles and fertility.
5. Some other medical conditions: Pioglitazone may also be used in the treatment of other medical conditions such as non-alcoholic fatty liver disease (non-alcoholic steatohepatitis), although its use for this purpose may be less common and requires further research.

Release form

Pioglitazone improves tissue sensitivity to insulin, promoting more efficient utilization of sugar in the body, and reduces the amount of glucose produced by the liver.

Form of release:

Pioglar is usually available in the form of oral tablets. Available dosages vary and may include, but are not limited to, the following:

• Tablets 15 mg
• 30 mg tablets
• 45 mg tablets

This allows the doctor to customize the dosage for each patient depending on their needs and response to treatment. The tablets are usually taken once a day, with or without food, as recommended by the doctor.

It's important to know:

Before starting Pioglar and during treatment, blood counts, including blood sugar levels and liver function, should be monitored regularly. It is also important to follow the diet and exercise plan recommended by your doctor for best treatment results.

Pioglitazone may be contraindicated in certain conditions, such as heart failure, and may interact with other medications, so you should notify your doctor of all medications you are taking and existing medical conditions before using it.

Pharmacodynamics

1. Improved insulin sensitivity: Pioglitazone acts as an agonist of the nuclear proliferator-activated receptor gamma receptor (PPAR-γ), which is a key regulator of gene expression involved in glucose and fat metabolism. Increased PPAR-γ activity contributes to improved tissue sensitivity to insulin, leading to a decrease in blood glucose levels.
2. Improved glycemic control: Pioglitazone reduces glycemic levels by stimulating glucose utilization in muscle and adipose tissue and reducing glucose production in the liver.
3. Reducing triglyceride and LDL levels: The drug can also reduce triglyceride and low-density lipoprotein (LDL) levels, which may help reduce the risk of cardiovascular disease in patients with diabetes.
4. Anti-inflammatory effects: Some studies suggest that pioglitazone may have anti-inflammatory effects by reducing levels of cytokines and other inflammatory markers.
5. Improvement of pancreatic β-cell function: Some evidence suggests that pioglitazone may improve pancreatic β-cell function, thereby improving insulin secretion.

Pharmacokinetics

1. Absorption: Pioglitazone is absorbed from the gastrointestinal tract after oral administration. Food intake may slightly delay its absorption, but does not significantly affect the final plasma concentration.
2. Distribution: After absorption pioglitazone is rapidly distributed throughout the tissues of the body. It binds to blood plasma proteins in a small volume (about 99%).
3. Metabolism: Pioglitazone undergoes extensive metabolism in the liver through the processes of glucuronidation and hydroxylation. The main metabolite is the active metabolite formed after hydroxylation.
4. Excretion: Pioglitazone and its metabolites are mainly excreted via the kidneys, as conjugates with glucuronic acid, and also via the intestine.
5. Half-life: The half-life of pioglitazone is about 3-7 hours, while for its main metabolite this time is about 16-24 hours.

Dosing and administration

1. Dosage: Usually the initial dose of pioglitazone is 15 or 30 mg once a day. Subsequently, the doctor may recommend increasing the dose to the maximum allowable dose depending on the effectiveness and tolerability of the drug. The maximum recommended daily dose of pioglitazone is 45 mg.
2. Use with food: Pioglitazone is usually taken with a meal or immediately after a meal to reduce the possibility of GI side effects.
3. Regular intake: Pioglitazone should be taken daily at the same time for best effect.
4. Compliance with doctor's instructions: It is important to follow the doctor's recommendations and instructions for use that come with the drug. The dosage may be adjusted depending on the individual characteristics of the patient and his response to treatment.
5. Condition monitoring: During treatment, your doctor may recommend regular monitoring of blood sugar and other parameters to assess the effectiveness and safety of treatment.
6. Compliance with additional instructions: Patients should also follow their physician's recommendations regarding diet, physical activity, and other aspects of diabetes management in conjunction with taking pioglitazone.

Use Pioglara during pregnancy

The use of Pioglitazone during pregnancy may be limited due to insufficient data on its safety in pregnant women.

It is important to note that pioglitazone belongs to the FDA (US Food and Drug Administration) classification of Group C drugs. This means that negative effects on fetal development have been identified based on animal studies, but no controlled and well-designed studies have been conducted on pregnant women.

Therefore, the use of pioglitazone during pregnancy is generally not recommended. If a woman was taking pioglitazone before she knew she was pregnant, she should see her doctor immediately to review her treatment and plan a diabetes management strategy during pregnancy.

Together, the patient and her doctor should carefully weigh the potential risks and benefits of continuing or stopping treatment with pioglitazone during pregnancy. In some cases, the doctor may decide that continuing treatment is necessary to manage diabetes and maintain the health of the mother.

Contraindications

1. Serious cardiovascular disease: Patients with serious cardiovascular disease such as heart failure should not use pioglitazone.
2. Serious hepatic disease: Pioglitazone may exacerbate hepatic problems, so it is contraindicated in patients with serious hepatic disease.
3. Pregnancy and breastfeeding: Pioglitazone is generally not recommended for use during pregnancy or breastfeeding due to insufficient data on its safety in these conditions.
4. Patients at risk for bone development or osteoporosis: Pioglitazone may increase the risk of bone development and osteoporosis, so it should be used with caution in patients at high risk for these conditions.
5. Urolithiasis: In patients with urolithiasis the use of pioglitazone may be undesirable due to possible worsening of the situation.
6. Urinary tract diseases: Pioglitazone may cause worsening of renal function, therefore it should be used with caution in patients with urinary tract diseases.
7. Hypoglycemia: In patients with low blood sugar levels, pioglitazone may increase the hypoglycemic effects of other drugs such as insulin or sulfonylureas, which may lead to the development of hypoglycemia.

Side effects Pioglara

1. Swelling: One of the most common side effects of pioglitazone is fluid retention in the body, which can lead to swelling, especially in the lower extremities.
2. Weight gain: In some patients, pioglitazone may lead to weight gain due to fluid retention and increased body fat.
3. Hypoglycemia: Pioglitazone may increase insulin sensitivity, which may lead to lower blood sugar levels. This may cause hypoglycemia, especially in patients taking blood sugar-lowering medications.
4. Gastrointestinal disorders: Digestive side effects such as nausea, vomiting, diarrhea or abdominal pain may occur.
5. Myalgia: Some patients may experience pain or soreness in the muscles, known as myalgia.
6. Increase in blood fats: Pioglitazone may affect blood lipid levels, causing an increase in triglyceride levels and a decrease in LDL (low-density lipoprotein) cholesterol levels.
7. Increased risk of cardiovascular events: In some patients, especially those with existing cardiovascular disease, the use of pioglitazone may increase the risk of cardiovascular events.
8. Increased risk of urolithiasis: Some studies have linked pioglitazone to an increased risk of urolithiasis.

Overdose

An overdose of pioglitazone (trade name Pioglar) can lead to various serious consequences. However, information on the exact symptoms and treatment of overdose with this drug is limited. If an overdose occurs, an increase in undesirable effects characteristic of the drug may occur, including hypoglycemia (decreased blood sugar level), hyperglycemia (increased blood sugar level), gastric disorders, drowsiness, dizziness, fatigue, and other symptoms associated with impaired glucose metabolism.

It is important to seek immediate medical attention if an overdose of Pioglar is suspected. Treatment of overdose may include symptomatic therapy to manage symptoms and monitoring of blood sugar levels. The patient may also be prescribed activated charcoal to absorb drug residues in the gastrointestinal tract. In some cases, supportive measures and symptomatic treatment, including infusion therapy and blood glucose monitoring, may be required.

Interactions with other drugs

1. Insulin and sulfonylureas: Pioglitazone may increase the hypoglycemic effect of insulin and sulfonylureas. When using these drugs together, dosage adjustment may be required to prevent hypoglycemia.
2. Glucocorticoids and thyroid hormone derivatives: Use of pioglitazone with glucocorticosteroids or thyroid hormone derivatives may result in increased insulin resistance and require adjustment of pioglitazone dose.
3. Hemoaggregating drugs and anticoagulants: Pioglitazone may increase the effects of antiaggregants and anticoagulants such as acetylsalicylic acid, clofibrate and warfarin. This may lead to an increased risk of bleeding.
4. Hypolipidemic drugs: Co-administration of pioglitazone with hypolipidemic drugs such as statins or fibrates may result in increased treatment efficacy and improved blood lipid profile.
5. Drugs affecting the cytochrome P450 system: Pioglitazone may interact with other drugs affecting the cytochrome P450 system, such as inhibitors or inducers of this system. This may lead to changes in the concentration of pioglitazone in the body and require dosage adjustment.

Storage conditions

When storing the drug Pioglar (pioglitazone), certain conditions should be observed to preserve its quality and effectiveness. Here are the main recommendations:

1. Temperature: Pioglitazone should be stored at room temperature, which is usually between 20°C and 25°C (68°F to 77°F). Avoid storing the drug at extremely high or low temperatures.
2. Humidity: Pioglitazone should be stored in a dry place to avoid exposure to moisture. Therefore, the drug should be stored in a humidity-protected container or package.
3. Light: Avoid storing Pioglar in places where it will be exposed to direct sunlight or other light sources. It is best to store the drug in a dark place or in a package that protects it from light.
4. Packaging: Make sure that the packaging of Pioglar is securely closed after each use to prevent the ingress of moisture or air, which may adversely affect the quality of the drug.
5. Children and pets: Keep Pioglar out of the reach of children and pets to prevent accidental use.
6. Expiration date: Observe the expiration date of the drug indicated on the package. Do not use Pioglar after the expiration date, as this may lead to loss of its effectiveness.