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Cardiac failure and other cardiac effects: Pioglitazone, like other thiazolidinediones, can cause fluid retention when used alone or in combination with other antidiabetic agents, including insulin. Fluid retention may lead to or exacerbate heart failure. Patients should be observed for signs and symptoms of heart failure. Pioglitazone should be discontinued if any deterioration in cardiac status occurs.
MHRA (Medicines and Healthcare products Regulatory Agency)/CHM (Commission on Human Medicines) advice: Rosiglitazone and Pioglitazone cardiovascular safety (December 2007 and February 2008): Rosiglitazone and Pioglitazone should not be used in patients with heart failure or history of heart failure; incidence of heart failure is increased when rosiglitazone or Pioglitazone is combined with insulin.
Do not use Pioglitazone in patients with active bladder cancer.
Use Pioglitazone with caution in patients with a prior history of bladder cancer. The benefits of the blood sugar control with Pioglitazone should be weighed against the unknown risks for cancer recurrence.
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