Thiazolidinedione (PPAR-γ Agonist)

Pioglitazone

Brand names: Actos

Pioglitazone is a thiazolidinedione (glitazone) used in type 2 diabetes, usually as add-on therapy; it improves insulin sensitivity without causing hypoglycaemia alone.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Initiate pioglitazone tablets at 15 mg or 30 mg once daily. Limit initial dose to 15 mg once daily in patients with NYHA Class I or II heart failure. (2.1) If there is inadequate glycemic control, the dose can be increased in 15 mg increments up to a maximum of 45 mg once daily. (2.1) Obtain liver tests before starting pioglitazone tablets. If abnormal, use caution when treating with pioglitazone tablets, investigate the probable cause, treat (if possible) and follow appropriately. Monitoring liver tests while on pioglitazone tablets are not recommended in patients without liver disease. ( 5.3 ) 2.1 Recommendations for All Patients Pioglitazone tablets should be taken once daily and can be …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-05-17. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It activates PPAR-gamma nuclear receptors, increasing peripheral insulin sensitivity and glucose uptake.

Prescribing in practice

It causes fluid retention and can precipitate or worsen heart failure — avoid in heart failure or a history of it.
It is associated with a small increased risk of bladder cancer (avoid with active or past bladder cancer or unexplained haematuria) and with fractures.
It can cause weight gain and, rarely, hepatotoxicity; the effect builds over weeks.

Monitoring

Monitor HbA1c, weight and for signs of fluid overload/heart failure; check liver function if indicated; review the benefit periodically.

Counselling the patient

Report breathlessness, ankle swelling or rapid weight gain (fluid retention).
Report blood in the urine.
It does not usually cause low blood sugar on its own.

Evidence & guidelines

An option to intensify type 2 diabetes treatment (NICE NG28), avoided in heart failure and weighed against bladder-cancer and fracture risk.

Reference: PROACTIVE Trial (Dormandy et al, Lancet 2005); PIVENS Trial (Sanyal et al, NEJM 2010); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways