Actos (pioglitazone) Disease Interactions

There are 7 disease interactions with Actos (pioglitazone):

Thiazolidinediones (Includes Actos) ↔ Chf

Severe Potential Hazard, High plausibility

Applies to: Congestive Heart Failure

The use of thiazolidinediones, alone or in combination with other antidiabetic agents, has been associated with fluid retention and new onset or exacerbation of heart failure. An increased risk of cardiovascular events (heart failure worsening; new or worsening edema; new or worsening dyspnea; increases in heart failure medication; myocardial infarction; angina; cardiovascular hospitalization and deaths) has been reported with rosiglitazone therapy in type II diabetic patients with New York Heart Association (NYHA) Class I or II congestive heart failure compared to placebo. Likewise, overnight hospitalization for CHF was observed in 9.9% of diabetic patients with NYHA Class II and III heart failure on pioglitazone compared to 4.7% of patients on glyburide. An increased incidence of cardiovascular adverse events including edema and cardiac failure has also been reported in patients receiving a thiazolidinedione in combination with insulin relative to insulin and placebo. Therapy with thiazolidinediones should be administered cautiously and initiated at the lowest recommended dosage in patients with congestive heart failure. Thiazolidinediones are not recommended for the treatment of patients with NYHA Class III or IV cardiac status. Patients should be monitored for signs of worsening heart failure such as increased dyspnea, edema, and weight gain. Therapy should be discontinued if any deterioration in cardiac status occurs.

References

  1. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Actos (pioglitazone)" Takeda Pharmaceuticals America, Lincolnshire, IL.

Thiazolidinediones (Includes Actos) ↔ Edema

Moderate Potential Hazard, High plausibility

Applies to: Hypertension, Fluid Retention, Pleural Effusion, Pulmonary Edema

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

References

  1. "Product Information. Rezulin (troglitazone)." Parke-Davis, Morris Plains, NJ.
  2. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Actos (pioglitazone)" Takeda Pharmaceuticals America, Lincolnshire, IL.
View all 4 references

Thiazolidinediones (Includes Actos) ↔ Liver Disease

Moderate Potential Hazard, Moderate plausibility

Applies to: Liver Disease

Initiation of rosiglitazone or pioglitazone therapy is not recommended in patients who exhibit clinical evidence of active liver disease or increased baseline serum transaminase levels (ALT exceeding 2.5 times upper limit of normal). Use of these agents is also not recommended in patients who have experienced jaundice during treatment with troglitazone. The use of troglitazone, another agent in the thiazolidinedione class, has been associated with clinically significant elevations in liver enzymes, reversible jaundice, and idiosyncratic hepatocellular injury including rare cases of liver failure, liver transplants, and death. Injury has occurred after both short- and long-term treatment. While these effects have not been associated with other thiazolidinediones in clinical trials, concerns exist because of their structural similarities. In addition, isolated cases of hepatitis and hepatic enzyme elevations to 3 or more times the upper limit of normal have been reported with both rosiglitazone and pioglitazone during postmarketing use. Rarely, these events have involved hepatic failure with and without fatal outcome, although causality has not been established. Until more safety data are available, patients who are prescribed thiazolidinedione therapy should have serum transaminase levels checked at baseline and periodically thereafter as clinically necessary. Mild to moderate elevations (ALT less than or equal to 2.5 times ULN) require cautious use with more frequent monitoring to determine if the elevations resolve or worsen. Patients who develop potential symptoms of hepatic injury such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, and dark urine should have liver enzymes checked. Therapy should be withdrawn if ALT is elevated and persists above 3 times ULN or if jaundice develops.

References

  1. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.
  2. Gitlin N, Julie NL, Spurr CL, Lim KN, Juarbe HM "Two cases of severe clinical and histologic hepatotoxicity associated with troglitazone." Ann Intern Med 129 (1998): 36-8
  3. NeuschwanderTetri BA, Isley WL, Oki JC, Ramrakhiani S, Quiason SG, Phillips NJ, Brunt EM "Troglitazone-induced hepatic failure leading to liver transplantation - A case report." Ann Intern Med 129 (1998): 38-41
View all 11 references

Thiazolidinediones (Includes Actos) ↔ Premenopausal Anovulation

Moderate Potential Hazard, Moderate plausibility

Applies to: Premenopausal Anovulation

In premenopausal, anovulatory patients with insulin resistance, treatment with thiazolidinediones may result in resumption of ovulation. Due to improved insulin sensitivity, pregnancy can occur if adequate contraception is not used.

References

  1. "Product Information. Rezulin (troglitazone)." Parke-Davis, Morris Plains, NJ.
  2. "Product Information. Actos (pioglitazone)" Takeda Pharmaceuticals America, Lincolnshire, IL.
  3. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.

Thiazolidinediones (Includes Actos) ↔ Type I Diabetes

Moderate Potential Hazard, High plausibility

Applies to: Diabetes Type 1, Diabetic Ketoacidosis

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

References

  1. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Actos (pioglitazone)" Takeda Pharmaceuticals America, Lincolnshire, IL.

Thiazolidinediones (Includes Actos) ↔ Weight Gain

Moderate Potential Hazard, High plausibility

Applies to: Obesity

Thiazolidinediones can cause dose-related weight gain, which may be undesirable in obese patients attempting to lose weight. The mechanism of weight gain is unclear but probably involves a combination of fluid retention and fat accumulation. In postmarketing experience with rosiglitazone, there have been reports of unusually rapid increases in weight and increases in excess of that generally observed in clinical trials. Patients who experience such increases should be assessed for fluid retention and volume-related events such as excessive edema and congestive heart failure.

References

  1. "Product Information. Actos (pioglitazone)" Takeda Pharmaceuticals America, Lincolnshire, IL.
  2. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.

Thiazolidinediones (Includes Actos) ↔ Anemia

Minor Potential Hazard, Moderate plausibility

Applies to: Anemia

Thiazolidinediones can cause slight decreases in hemoglobin and hematocrit. In clinical studies, hemoglobin levels were reduced primarily within the first 4 to 12 weeks of therapy but remained relatively constant thereafter. These changes may be related to increased plasma volume and have rarely been associated with any significant hematologic clinical effects. Nevertheless, caution may be advisable when thiazolidinediones are prescribed to patients with certain anemias.

References

  1. "Product Information. Avandia (rosiglitazone)" SmithKline Beecham, Philadelphia, PA.
  2. "Product Information. Actos (pioglitazone)" Takeda Pharmaceuticals America, Lincolnshire, IL.

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Actos (pioglitazone) drug Interactions

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Actos (pioglitazone) alcohol/food Interactions

There are 3 alcohol/food interactions with Actos (pioglitazone)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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