Before starting
Required
- Baseline
- Full blood count
- HbA1c
- Liver function tests do not initiate if ALT greater than 2.5 upper limit of normal or other evidence of liver disease
- Urinalysis to detect macroscopic haematuria; if present, investigate before starting
- Weight
Ongoing once stable
Consider
- 6 monthly
- HbA1c Discontinue if no response after 3-6 months
- At least annually
- Liver function tests if ALT greater than 3 upper limit of normal: reassess as soon as possible; discontinue if persists
Notes
Advice to patients
Advise patients to seek immediate medical attention if develop:
- symptoms such as nausea, vomiting, abdominal pain, fatigue, anorexia and dark urine develop
- symptoms of macroscopic haematuria or other symptoms such as dysuria or urinary urgency
- disturbances in visual acuity (worsening or new onset macular oedema possible; consider ophthalmological referral)
Bibliography
- Takeda UK Ltd. Summary of Product Characteristics – Actos Tablets. Last revised 07/2018 [cited 09/01/2020]
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [cited 30/06/2020]
- NICE Clinical Knowledge Summaries (CKS). Diabetes – type 2. Updated Sep 2019 [cited 30/07/2020]
- National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management [NG28]. Dec 2015[updated Dec 2020; cited 30/07/2020]
- Medicines and Healthcare products Regulatory Agency. Insulin combined with pioglitazone: risk of cardiac failure. Drug Safety Update Jan 2011, vol 4 issue 6: A2 [cited June 2020]
- Medicines and Healthcare products Regulatory Agency. Pioglitazone: risk of bladder cancer. Drug Safety Update vol 5 issue 1, Aug 2011: A1 [cited June 2020]