Tag Archives: pioglitazone

Does Diabetes Drug Pioglitazone Prevent Dementia?

Nobody knows. A recent report out of Germany suggests that pioglitazone does prevent dementia, but it’s not a very strong linkage. If it works, I wonder if it’s simply related to better control of blood sugar, which could be accomplished with a variety of means. Pioglitazone (aka Actos) is a type 2 diabetes drug in the TZD class. You could call it an “insulin sensitizer.”

The best popular press report I’ve seen is at Bloomberg.

German researchers went fishing for associations in a huge database of patients and drug usage. Their formal report hasn’t even been published yet. A five-year study was recently initiated to further investigate the possibility that piogoitazone prevents dementia. I doubt this will pan out.

Steve Parker, M.D.

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Trouble Seeing? Might Be Your Diabetes Drug

Macular edema is two to five times more common in type 2 diabetics taking pioglitazone or rosiglitazone, according to an article published June 11, 2012, by MedPage Today.  The original research was reported in Archives of Internal Medicine.

The macula is the dark area in the middle of the right half of this retina photo

The macula is the most sensitive part of the retina at the back of your eyeball.  Edema, or watery swelling, of the macula can impair vision.

Very few patients in the U.S. use rosiglitazone any longer because of concerns about heart toxicity.  Pioglitazone has recently been implicated as a cause of bladder cancer.

You can avoid some diabetes drug complications by controlling blood sugars with diet and exercise.

Steve Parker, M.D. 

Reference:
Idris I, et al “Association between thiazolidinedione treatment and risk of macular edema among patients with type 2 diabetes” Arch Intern Med 2012; DOI:10.1001/archinternmed.2012.1938.

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Filed under Diabetes Complications, Drugs for Diabetes

Pioglitazone and Bladder Cancer

MedPage Today reports that another study links pioglitazone with bladder cancer in the U.K.  I’m not sure how the U.S. Food and Drug Administration will react to this.

We have 11 classes of drugs for treatment of diabetes.  Thiazolidinediones, aka glitazones or TZDs, are one class.  Pioglitazone and rosiglitazone are the only two drugs in the class, at least in the U.S.  Rosiglitazone is already highly restricted due to concern about heart toxicity.

This latest news confirms my inclination to treat type 2 diabetes with weight management, exercise, and a low-carbohydrate diet, when able.

Steve Parker, M.D.

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Bladder Cancer Linked With Diabetes Drugs in Thiazolidinedione Class

MedPage Today reports that thiazolidinediones (aka glitazones) are linked to development of bladder cancer.  Pioglitazone is the most commonly used TZD in the U.S.  From the article:

The increased risk of bladder cancer associated with glitazones — which reached a relative increase of 72% in patients who started on the agents more than 5 years earlier — “appears to be a class effect,” the research team, led by Ronac Mamtani, MD, of the University of Pennsylvania in Philadelphia, concluded.

According to the National Cancer Institute, the U.S. has 74,000 new cases of bladder cancer yearly, and 15,000 annual deaths from bladder cancer.

If you take a thiazolidinedione, talk to your doctor about bladder cancer at your next visit.

Steve Parker, M.D.

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France Pulling Diabetic Drug Pioglitazone From Pharmacy Shelves

Bloomberg reported yesterday that the French drug agency is pulling pioglitazone from the market in view of its recent association with bladder cancer.  I mentioned this here May 14.  Pioglitazone is sold in the U.S. as Actos.  I don’t expect the U.S. Food and Drug Administration to follow suit soon.

Steve Parker, M.D.

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Yet Another Diabetes Drug: Linagliptin

On May 2, 2011, the U.S. Food and Drug Administration approved the use of linagliptin for adults with type 2 diabetes.  It’s in the class called DPP-4 inhibitors.  You’ll see it sold in the U.S. as Tradjenta

How do they come up with names like Tradjenta?  The manufacturer wants it unique, so there are no claims of copyright infringement.  You also want to avoid sounding like another drug on the market, to avoid mixing up the drugs.  A committee is usually involved to consider all the angles, especially marketing.

How Does Linagliptin Work?

It’s complicated.  It inhibits an enzyme, dipeptidyl peptidase-4, ultimately leading to insulin release from the pancreas into the bloodstream, and lowered glucagon levels. 

Any Side Effects?

Linagliptin may slightly increase the risk of pancreatitis.  It seems to be pretty well tolerated overall, with the most common adverse effects being a runny or stuffy nose, or sore throat.  When given with an insulin secretagogue drug, like sulfonylureas, linagliptin can increase the odds of hypoglycemia.  Due to an interaction, it’s best not to use linagliptin with rifampin.

What’s the Dose?

Only one: 5 mg by mouth daily.  No need to adjust the dosage for underlying kidney or liver disease or age.

Usage

It’s for adults with type 2 diabetes.  It may be used as the sole diabetic drug along with diet and exercise.  It can also be used in combination with metformin, a sulfonylurea, or pioglitazone.  It’s not been studied in people taking insulin, in pregnancy, or in nursing mothers, so it’s best to avoid those settings for now.

Steve Parker, M.D.

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Rosiglitazone Severely Restricted by FDA

MedPageToday reported yesterday on the U.S. Food & Drug Administration’s ruling that the diabetes drug rosiglitazone should be used in new patients only if blood sugars are not controlled with other diabetes drugs, such as pioglitazone.

It sounds as if new users and their doctors may have to jump through some paperwork hoops to get the drug, which is more reason not to prescribe it.

The problem is that scientific studies suggest that rosiglitazone increases the risk of heart attack, heart failure, and death.

Steve Parker, M.D.

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