Nurses Compass
Drug Guide
Pioglitazone Hydrochloride and Glimepiride
Classification
Therapeutic: Antidiabetic agent
Pharmacological: Thiazolidinedione (Pioglitazone) and Sulfonylurea (Glimepiride)
FDA Approved Indications
- Type 2 diabetes mellitus, to improve glycemic control
Mechanism of Action
Pioglitazone activates PPAR-gamma nuclear receptors, increasing insulin sensitivity in adipose tissue, muscle, and the liver. Glimepiride stimulates insulin release from pancreatic beta cells.
Dosage and Administration
Adult: Often once daily with or without food; dosage varies based on glycemic response.
Pediatric: Not approved for pediatric use.
Geriatric: Start at lower dose; monitor closely due to increased risk of hypoglycemia and fluid retention.
Renal Impairment: Adjust dosage in renal impairment; cautious use.
Hepatic Impairment: Use with caution; contraindicated in severe hepatic disease.
Pharmacokinetics
Absorption: Rapidly absorbed after oral administration.
Distribution: Pioglitazone binds extensively to plasma proteins; Glimepiride also highly protein-bound.
Metabolism: Primarily metabolized by the liver (CYP2C8 for pioglitazone, CYP2C9 for glimepiride).
Excretion: Excreted mainly via urine and feces.
Half Life: Pioglitazone approximately 3-7 hours; active metabolites have longer half-lives; Glimepiride approximately 5-9 hours.
Contraindications
- Hypersensitivity to pioglitazone, glimepiride, or excipients.
- NYHA Class III or IV Heart failure.
Precautions
- Use cautiously in history of edema, heart failure, risk factors for congestive heart failure, hepatic impairment, or bladder cancer.
Adverse Reactions - Common
- Hypoglycemia (Common)
- Weight gain (Common)
- Edema (Common)
- Upper respiratory tract infection (Common)
Adverse Reactions - Serious
- Congestive heart failure exacerbation (Serious)
- Bladder cancer (Serious)
- Hepatotoxicity (Serious)
Drug-Drug Interactions
- Insulin and other antidiabetics (risk of hypoglycemia)
- CYP2C8 inhibitors (such as gemfibrozil) increase pioglitazone levels
- CYP2C8 inducers (such as rifampin) decrease pioglitazone levels
Drug-Food Interactions
- Alcohol may increase risk of hypoglycemia or lactic acidosis.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood glucose levels, liver function tests, signs of fluid retention, and heart failure symptoms.
Diagnoses:
- Risk for hypoglycemia
- Impaired skin integrity (due to edema)
Implementation: Administer as prescribed, monitor blood glucose regularly, educate patient on signs of hypoglycemia and fluid retention.
Evaluation: Assess glycemic control, monitor for adverse reactions, and adjust therapy accordingly.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Monitor blood glucose regularly.
- Be aware of hypoglycemia symptoms: sweating, shaking, dizziness.
- Report swelling, weight gain, or signs of heart failure.
- Maintain a healthy diet and exercise regimen.
Special Considerations
Black Box Warnings:
- Heart failure risk with thiazolidinediones.
- Potential increased risk of bladder cancer with pioglitazone.
Genetic Factors: Varied metabolism; CYP enzyme polymorphisms may affect drug levels.
Lab Test Interference: None noted.
Overdose Management
Signs/Symptoms: Severe hypoglycemia, weight gain, edema.
Treatment: Immediate administration of glucose or glucagon; supportive care; monitor cardiac status and fluid balance.
Storage and Handling
Storage: Store at controlled room temperature 20°C to 25°C (68°F to 77°F).
Stability: Stable for the duration of the labeled shelf life when stored properly.