Govt directive warns that Pioglitazone should not be first line of therapy
Diabetes drug pioglitazone and its combinations are back, but with a box warning in “bold red letters” to caution patients.
For a drug suspended a month ago for its possible links to urinary bladder cancer, its revocation could end up being a tough pill to swallow, especially for new patients with type II diabetes, say doctors.
Patients who have controlled diabetes with pioglitazone may still go back to the drug, says diabetologist Rajiv Kovil.
But putting new patients on pioglitazone may fall by at least two-thirds, he says, as they would be “extremely anxious”.
An engineer by profession, 43-year-old Rishi Kumar, for instance, would not like to take the medicine, now that he has doubts about its safety. He would, in fact, go for a second opinion if he is prescribed the medicine again.
Pioglitazone is used as a third line of treatment. In its latest directive, the Government has emphasised the need for caution, insisting that the drug not be used as the first line of therapy, says Kovil.
The Government has brought back pioglitazone with several riders. Doctors need to run tests on the patient before initiating treatment, restrict use of the drug in elderly patients and prescribe it only after knowing the patient’s history.
It also requires patients on pioglitazone to be put through 3-6 monthly reviews.
Diabetologist V. Mohan is happy that, after much discussion, the Government has laid down several conditions on the use of pioglitazone. He was also involved in the discussions on pioglitazone and its suspension.
Patients will go by what the doctor says, and the doctor needs to share all these risks with the patient before starting the drug, he points out.
Precisely the sentiment of 69-year-old A.N. Dutta, suffering from type-2 diabetes for 10 years.
“I would not like to second-guess my doctor on this issue. Ultimately, it is about having faith in your doctor’s judgment. Now that the ban has been revoked, if he prescribes the medicine (piloglitazone) again, I will take it,” he says.