Pioglitazone Risks, Warnings, and Complications

CONGESTIVE HEART FAILURE: Taking pioglitazone alone or with other oral diabetes medications or insulin can cause fluid retention in the body. This can cause or worsen congestive heart failure. Before starting pioglitazone, tell your healthcare provider if you have uncontrolled heart failure. Your doctor may avoid prescribing this diabetes drug if you have New York Heart Association Class III or Class IV heart failure. Tell your doctor right away if you develop symptoms of congestive heart failure, such as sudden weight gain, shortness of breath (especially with activity or lying down), weakness, unusual tiredness, decreased ability to exercise, swelling in the lower legs, or swelling in the abdominal area. 

LIVER INJURY: There are reports of pioglitazone causing liver inflammation and elevation in liver enzymes, potentially leading to liver failure. Before starting pioglitazone, talk with your doctor if you have a history of liver disease, such as alcoholic or nonalcoholic fatty liver disease. Keep all your healthcare appointments during treatment with pioglitazone. Your doctor may want to check liver enzymes periodically. Tell your doctor right away if you develop right upper stomach pain, yellowing of the skin or eyes, dark urine, or light-colored stools while on this medicine. 

BLADDER CANCER: Animal studies have shown that taking Actos at high doses can increase the risk of developing bladder cancer. An increased bladder cancer risk has not been identified in human clinical trials or studies. Nonetheless, tell your doctor if you have had bladder cancer or have risk factors for it. 

MACULAR EDEMA: Diabetic patients taking pioglitazone or other thiazolidinediones can develop macular edema (swelling in the central part of the retina), resulting in blurred vision or decreased vision. The macular edema sometimes improves after discontinuing pioglitazone. However, it is unclear whether there is a direct relationship between pioglitazone and macular edema. Make sure you keep all your appointments for regular eye exams while on this medicine. Tell your doctor right away if you develop any eye symptoms.

BONE FRACTURES: Studies have shown that female patients taking pioglitazone are at an increased risk of bone fractures. Talk with your doctor if you have other risk factors for osteoporosis (weak bones) and ways to keep your bones healthy. 

HYPOGLYCEMIA: Pioglitazone lowers blood sugar and can sometimes cause severe hypoglycemia (very low blood sugar). The risk of this happening is higher if you take other medications that can also cause low blood sugar. Talk with your doctor about the appropriate frequency of blood sugar testing at home. Make sure you know how to recognize the signs of low blood sugar (fast heartbeat, sweating, shakiness, anxiety, nervousness, dizziness, hunger, confusion). Talk with your doctor about how to quickly treat hypoglycemia (eating or drinking glucose tablets, fruit juice, regular non-diet soda, sugar candy, or honey is usually recommended). Your doctor may recommend having an emergency glucagon injection kit on hand. They may adjust your pioglitazone dose, the dose of your other diabetes medications, or your insulin dose if low blood sugar effects occur.