Pioglitazone (Actos®)
Dosage forms
Tablet
- 15 mg
- 30 mg
- 45 mg
Dosing
Type two diabetes
- Starting: 15 - 30 mg once daily
- Maintenance: 15 - 45 mg once daily
- Max: 45 mg once daily
- May take without regard to food
Generic / Price
- YES/$Other
- For patients with NYHA I and II heart failure, starting dose should be 15 mg
- Dose should not exceed 15 mg/day when taken with CYP2C8 strong inhibitor
Rosiglitazone (Avandia®)
Dosage forms
Tablet
- 2 mg
- 4 mg
- 8 mg
Dosing
Type two diabetes
- Starting: 4 mg/day
- Maintenance: 4 - 8 mg/day
- Max: 8 mg/day
- May be given in 1 or 2 divided doses
- May take without regard to food
Generic / Price
- NO/$$$$Other
- Twice a day dosing may be slightly more efficacious (see efficacy for more)
- Rosiglitazone is a CYP2C8 sensitive substrate
- GLITAZONE + METFORMIN
Actoplus met® (pioglitazone + metformin)
Dosage forms
Tablet
- Pioglitazone - Metformin
- 15 mg - 500 mg
- 15 mg - 850 mg
Dosing
Type 2 diabetes
- Starting: 15/500 mg twice daily or 15/850 mg once daily
- Max: pioglitazone 45 mg/day | metformin 2550 mg/day
- Titrate to effect
- May be given in one or two divided doses
- Take with food to decrease GI upset
Generic / Price
- YES/$$Actoplus met XR® (pioglitazone + metformin ER)
Dosage forms
Tablet, extended-release
- Pioglitazone - Metformin ER
- 15 mg - 1000 mg
- 30 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 15/1000 - 30/1000 mg once daily
- Max: pioglitazone 45 mg/day | metformin ER 2000 mg/day
- Titrate to effect
- May be given in one or two divided doses
- Take with food to decrease GI upset
Generic / Price
- NO/$$$$Other
- Swallow whole. Do not crush, cut, or chew tablet.
- Inactive ingredients may occasionally be eliminated in the feces as a soft mass that may resemble the original tablet
Avandamet® (rosiglitazone + metformin)
Dosage forms
Tablet
- Rosiglitazone - Metformin
- 2 mg - 500 mg
- 2 mg - 1000 mg
- 4 mg - 500 mg
- 4 mg - 1000 mg
Dosing
Type 2 diabetes
- Starting: 2/500 mg twice daily
- Max: rosiglitazone 8 mg/day | metformin 2000 mg/day
- Titrate to effect
- Take with food to decrease GI upset
Generic / Price
- NO/$$$$- GLITAZONE + SULFONYLUREA
Duetact® (pioglitazone + glimepiride)
Dosage forms
Tablet
- Pioglitazone - Glimepiride
- 30 mg - 2 mg
- 30 mg - 4 mg
Dosing
Type 2 diabetes
- Starting: 30/2 - 30/4 mg once daily
- Max: 30/4 mg once daily
- Titrate to effect
- Take with first main meal
Generic / Price
- YES/$$$- GLITAZONE + DPP-4 INHIBITOR
Oseni® (pioglitazone + alogliptin)
Dosage forms
Tablet
- Alogliptin - Pioglitazone
- 12.5 mg - 15 mg
- 12.5 mg - 30 mg
- 12.5 mg - 45 mg
- 25 mg - 15 mg
- 25 mg - 30 mg
- 25 mg - 45 mg
Dosing
Type two diabetes
- Starting: 25/15 - 25/30 mg once daily
- Max: 25/45 mg once daily
- Titrate to effect
- May take without regard to food
Generic / Price
- YES/$$$-$$$$Other
- Do not split tablets
- Kidney disease dosing
- Pioglitazone (Actos®)
- No dose adjustment necessary
- Rosiglitazone (Avandia®)
- No dose adjustment necessary
- Liver disease dosing
- Pioglitazone (Actos®)
- No dose adjustment necessary
- Rosiglitazone (Avandia®)
- Rosiglitazone exposure is increased 3-fold in patients with Child-Pugh B/C liver disease
- Therapy with rosiglitazone should not be initiated in patients with active liver disease or increased baseline liver enzyme levels (ALT > 2.5 X upper limit of normal)
- Discontinue rosiglitazone in patients with ALT levels > 3 X upper limit of normal
- DRUG INTERACTIONS
- NOTE: Drug interactions presented here are NOT all-inclusive. Other interactions may exist. The interactions presented here are meant to encompass commonly prescribed medications and/or interactions that are well-documented. Always consult your physician or pharmacist before taking medications concurrently. CLICK HERE for more information on drug interactions.
- Rosiglitazone and Pioglitazone
- CYP2C8 inhibitors and inducers - Pioglitazone and rosiglitazone are both CYP2C8 sensitive substrates. CYP inhibitors (e.g. gemfibrozil) may increase glitazone levels and CYP inducers (e.g. rifampin) may decrease glitazone levels. Appropriate dose adjustments should be made when taken together. Pioglitazone dose should not exceed 15 mg a day when taken with a strong CYP2C8 inhibitor.
- Insulin - Glitazones may cause fluid retention. This effect may be worsened when glitazones are used with insulin. Patients with congestive heart failure who require insulin should not take glitazones.
- Pregabalin (Lyrica®) - Pregabalin may potentiate the fluid retention caused by glitazones
- Pioglitazone (Actos®)
- Topiramate (Topamax®) - topiramate may decrease pioglitazone levels. The clinical relevance of this effect is unknown.
- Metabolism and clearance
- PRICE ($) INFO
Pricing legend
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $150
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
- BIBLIOGRAPHY
- Manufacturer Package Insert