Pharmacotherapy of Pioglitazone and Its Current Status in India

Abstract

In the management of type-2 diabetis mellitus ie insulin resistance has become easier due to the discovery of Thiazolidinediones (also called Glitazones), other than Biguanides. However the adverse effects of Pioglitazone especially bladder cancer on long term use had made uncertain future regarding their safety. Purpose of this review article is to understand the pharmacology of Pioglitazone and its current status in India. Data was collected from Review articles, Standard pharmacology text books, Pharmacology journals and Electronic data base like Medline. They were analysed and relevant data was collected. There is no doubt at all regarding the therapeutic potential of the Glitazone group of drugs. Both Pioglitazone and Rosiglitazone have been hugely successful in controlling the HbA1c levels in a large number of patients with type 2 diabetes. Insulin resistance is more common in Asian indians and hence Glitazones have been very popular in India. However the correlation between Pioglitazone and bladder cancer is seen with duration of the therapy more than 24 months and cumulative dose of an average daily dose of Pioglitazone of about 40 mg/day. In India, we generally do not use doses greater than 30 mg, which means, to achieve a cumulative dose we would take longer and if we use low dose 7.5 mg Pioglitazone, whether Indians are equally, more, or less, prone to risk of bladder cancer than Europeans has to be further studied.