Clopidogrel
Severe
Database
Drug interaction classified as: metabolism.
Source: DDInter
Drug reference
Pioglitazone
Thiazolidinedione (TZD / glitazone) / PPAR-gamma agonist · Antidiabetic
Also known as Pioglitazone Hydrochloride, TZD, Actos
START
15-30 mg OD; check baseline LFTs, HbA1c, weight, signs of heart failure, fracture risk, history of bladder cancer; counsel on weight gain and edema risk
TYPICAL MAX
45 mg/day
STOP IF
Signs of heart failure (dyspnea, edema, weight gain >2-3 kg rapidly), hematuria (bladder cancer screen), jaundice, LFTs >3x ULN, macular edema symptoms
WATCH
HbA1c at 8-12 weeks then 3-monthly, weight at each visit, edema/BP, LFTs at baseline and periodically, fracture risk (especially women), urine for hematuria annually if >1 year use
CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC A10BG03
KDIGO 2024 + manufacturer label
- ONSET
- 30min · absorption onset
- PEAK
- 2h · Peak plasma concentration
- t½
- 5h · 3-7 hours (parent); metabolites longer
- DURATION
- 1d · Once-daily dosing
EXCRETION
Fecal (metabolites)
route + CYP
INTERACTIONS
9 major
SEVERE in our sources
PREGNANCY
Avoid in pregnancy; animal studies show fetal harm; Category C
FDA category + note
Top interactionssee all 12 →
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Available in India
162 branded formulations and 2 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Selective agonist at peroxisome proliferator-activated receptor gamma (PPAR-gamma), a nuclear transcription factor. Activation enhances insulin sensitivity in peripheral tissues (muscle, adipose, liver) by increasing glucose uptake, reducing hepatic gluconeogenesis, and improving lipid metabolism. Also promotes adipocyte differentiation and shifts fat from visceral to subcutaneous deposits.
Indications
Type 2 diabetes mellitus (monotherapy or combination)Non-alcoholic fatty liver disease (NAFLD/NASH) - off-labelPolycystic ovary syndrome (PCOS) - off-label
Dosing
- Adult
- 15-30 mg once daily; may increase to 45 mg once daily after 1-2 months if inadequate glycemic control; take with or without food
- Pediatric
- Not recommended under 18 years
- Renal adjustment
- No adjustment needed; not renally excreted
- Hepatic adjustment
- Avoid if ALT >2.5x ULN; check LFTs before starting
- Geriatric
- Standard dosing; increased risk of heart failure and fractures
- Max dose
- 45 mg/day
Pharmacokinetics
Onset
Days to weeks (insulin sensitization takes time)
Peak effect
2 hours (Tmax); HbA1c reduction evident at 8-12 weeks
Duration
24 hours
Half-life
3-7 hours (parent); active metabolites: 16-24 hours
Bioavailability
>80%
Protein binding
>99% (bound to albumin)
Metabolism
Hepatic CYP2C8 (major) and CYP3A4 (minor); extensive metabolism to active metabolites (M-III and M-IV)
Excretion
Fecal (majority, as metabolites); renal (<15%)
Contraindications
- New York Heart Association (NYHA) Class III-IV heart failure
- History of bladder cancer (controversial - relative contraindication)
- Severe hepatic impairment (ALT >2.5x ULN)
- Diabetic ketoacidosis
- Hypersensitivity to pioglitazone
Side effects
Common
Weight gain (dose-dependent, 2-4 kg typical)Edema / fluid retentionHeadacheMuscle painSore throatUpper respiratory infection
Serious
- Heart failure / fluid overload (black box warning)
- Bladder cancer (possible increased risk with long-term use >1 year)
- Hepatotoxicity (rare)
- Bone fractures (distal extremities, especially in women)
- Macular edema (rare)
- Hypoglycemia (when combined with insulin or sulfonylureas)
- Severe allergic reactions
Pregnancy & lactation
Pregnancy
Avoid in pregnancy; animal studies show fetal harm; Category C
Lactation
Excretion in breast milk unknown; avoid during breastfeeding
Drug interactions
Gatifloxacin
Severe
Database
Clinical effect not specified
Source: DDInter
Gemfibrozil
Severe
Database
Increased plasma levels of pioglitazone.
A dose reduction is suggested for pioglitazone.
Source: DDInter
Leflunomide
Severe
Database
Clinical effect not specified
Source: DDInter
Lomitapide
Severe
Database
Clinical effect not specified
Source: DDInter
Lumateperone
Severe
Database
Clinical effect not specified
Source: DDInter
Mipomersen
Severe
Database
Clinical effect not specified
Source: DDInter
Pexidartinib
Severe
Database
Clinical effect not specified
Source: DDInter
Teriflunomide
Severe
Database
Clinical effect not specified
Source: DDInter
Oral Contraception
Moderate
Textbook
Failure of oral contraception may occur.
Advise women to use alternative or additional methods of contraception during pioglitazone therapy.
Source: KDT 7e · p277
Rifampin
Moderate
Textbook
Reduced efficacy of pioglitazone.
Monitor for reduced efficacy of pioglitazone and consider dosage adjustment.
Source: G&G 14e · p1036
Favipiravir
Moderate
Database
Increased plasma concentrations of pioglitazone, potentially increasing the risk of adverse effects such as fluid retention and heart failure.
Monitor for signs of pioglitazone toxicity. Consider reducing pioglitazone dose or using an alternative antidiabetic agent.
Related guidelines
MASLD / non-alcoholic fatty liver disease
INASL · Hepatology · 2023
MASLD / non-alcoholic fatty liver disease
AASLD · Gastroenterology · 2023
Gestational diabetes mellitus
FOGSI · Obstetrics & Gynaecology · 2023
Acute coronary syndrome in chronic kidney disease
CSI · Cardiology · 2020
Empirical antimicrobial use in common syndromes
ICMR · Infectious Diseases · 2019
Ask House about Pioglitazone
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19