The MHRA has reminded prescribers that combined use of pioglitazone and insulin may be associated with an increased risk of cardiac failure, especially in patients with underlying risk factors for this condition.
If the combination is used, patients should be observed for signs and symptoms of heart failure, weight gain, and oedema. Pioglitazone should be discontinued if any deterioration in cardiac status occurs.
Rosiglitazone, another member of the thiazolidinedione class, was withdrawn in 2010 in light of evidence linking it to adverse cardiovascular outcomes.
Further information: MHRA