Common questions about pioglitazone

Pioglitazone belongs to a group of diabetes medicines called thiazolidinediones (or glitazones).

It helps control your blood sugar levels by improving how your body uses a hormone called insulin. It does this by helping your cells become more sensitive to the insulin your body makes.

You will not necessarily feel any different when taking pioglitazone, as you may not have had any symptoms of diabetes. This does not mean that pioglitazone is not working. It's important to keep taking it.

Pioglitazone takes a few weeks to lower your blood sugar levels.

It will help keep your blood sugar stable and reduce your chances of getting problems related to diabetes in the future.

Pioglitazone is usually safe to take for a long time. Your doctor will give you regular tests to check whether it's OK for you to continue taking it.

People aged over 65 are slightly more likely to get some of the less common side effects of pioglitazone, such as heart failure.

Your doctor will make sure you have regular checks if they think there's a higher risk of side effects.

Pioglitazone does not usually cause low blood sugar (known as hypoglycaemia, or "hypos") when taken on its own.

If you're taking other medicines for diabetes, your doctor may recommend reducing the dose of these other medicines when you start pioglitazone. This will reduce the risk of hypos.

Taking pioglitazone together with insulin increases your risk of heart failure. The risk is higher if you're over 65 years old.

If you already have heart failure, there's a small chance that taking pioglitazone could make it worse.

If you're unusually short of breath, put on weight quickly or have swollen legs, feet or ankles (oedema), see your doctor straight away.

Pioglitazone is a thiazolidinedione (also known as a glitazone). It's the only one in this group of medicines available in the UK.

There are other medicines that can also treat type 2 diabetes including:

• metformin
• sulfonylureas, like gliclazide and glimepiride
• DPP-4 inhibitors, like saxagliptin
• SGLT2 inhibitors, like dapagliflozin
• GLP-1 agonists, like exenatide (given by injection)
• insulin (given by injection)

Metformin is usually the first choice of medicine used for treating type 2 diabetes.

Pioglitazone can be prescribed on its own or together with other diabetes medicines such as metformin, DPP-4 inhibitors and SGLT2 inhibitors.

Your doctor will advise you on the best way to treat your type 2 diabetes. They will look at your medical history and how your blood sugar levels respond to a medicine or combination of medicines.

If you have diabetes, you're entitled to free prescriptions for all of your medicines, not just your diabetes ones.

To claim your free prescriptions, you'll need to have a medical exemption certificate (FP92A). You can get an application form at your GP surgery. Once you've filled in the form, ask your doctor to sign it.

You can usually take pioglitazone before surgery and on the day of surgery too, even if you're not eating (fasting).

If you're going to have an operation, tell your doctor that you're taking pioglitazone. Also tell them about any other medicines you may be taking, including other diabetes medicines.

This is because medicines for type 2 diabetes can increase your risk of low blood sugar during the operation. Low blood sugar can be difficult to detect when you're having a general anaesthetic to put you to sleep.

Your doctor may change you to insulin for a few days before your operation.

Pioglitazone does not affect any type of contraception, including the combined pill and emergency contraception.

But talk to your doctor before starting to take contraceptive pills if you're already taking pioglitazone. They may change your dose of pioglitazone. This is because contraceptive pills change how your body handles sugar.

If your blood sugar levels are stable, then taking pioglitazone should not affect your ability to drive, cycle or use machinery and tools.

However, if you take pioglitazone with other medicines for type 2 diabetes, your blood sugar levels can become too low. This can reduce your concentration. If this happens to you, do not drive, cycle, or use machines or tools, until you feel better.

If your eyesight is affected by changes in your blood sugar, do not drive or use machinery until you can see clearly again. See your doctor or optician if your vision does not get better.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking pioglitazone. GOV.UK has more information on the law on drugs and driving.

Yes, you can drink alcohol while taking pioglitazone. But it's best to drink no more than 2 units a day. Drinking more than this can increase your risk of low blood sugar.

It's a good idea to cut down on foods with added sugar. Check the nutrition labels as many foods and drinks are high in sugar, such as:

• sweets
• cakes
• biscuits
• chocolate
• some fizzy drinks
• juice drinks

However, it's important to always carry a fast-acting carbohydrate with you, like sugar cubes, fruit juice or some sweets, in case your blood sugar level gets low. Artificial sweeteners will not help.

You may also need to eat a starchy carbohydrate, like a sandwich or a biscuit, to maintain your blood sugar for longer.

Be careful eating food and drink containing karela (also called bitter gourd) because it can lower your blood sugar levels and mean your diabetes is not controlled as well as it should be. Karela is used to flavour foods such as curries. It has a bitter taste and is also made into juice and tea.

Some people find they gain body fat when taking pioglitazone. This can make them put on weight.

Try to eat a healthy balanced diet without increasing your portion sizes, so you do not gain too much weight. Regular exercise will also help to keep your weight stable.

Pioglitazone can also make you retain water. If you put on weight, have swollen ankles, feet or legs (oedema), and have problems breathing, make an urgent appointment to see you doctor. These can be signs of heart failure.

There are some lifestyle changes you can make to help control the symptoms of diabetes. These include:

• eating a healthy diet
• losing excess weight
• not smoking
• cutting down on alcohol – try to keep to the recommended guidelines of no more than 14 units of alcohol a week.
• exercising – 30 minutes a day, 5 times a week is ideal

Pioglitazone is usually prescribed when diet and exercise alone have not been enough to control your blood sugar levels.