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Congestive Heart Failure: Thiazolidinediones, including pioglitazone, cause or exacerbate congestive heart failure in some patients (see Precautions). Monitor patients carefully for signs and symptoms of heart failure (eg, excessive, rapid weight gain, dyspnea, and/or edema) after initiation of pioglitazone and after dose increases. Manage heart failure according to current standards of care if these signs and symptoms develop. Consider discontinuation of pioglitazone or dose reduction.
Pioglitazone is not recommended in patients with symptomatic heart failure. Starting pioglitazone treatment in patients with established NYHA Class III or IV heart failure is contraindicated. (See Contraindications and Precautions.)
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