Pioglitazone reduces insulin resistance by acting as a PPAR-gamma agonist. A serious long-term adverse effect that limits its use in high-risk patients is:

• A Lactic acidosis due to mitochondrial electron transport chain inhibition
• B Pancreatitis due to hypertriglyceridaemia
• C Hepatotoxicity requiring liver function monitoring every 3 months
• D Increased risk of bladder cancer with prolonged use (>1 year) ✓

Explanation

Pioglitazone has been associated with an increased risk of bladder cancer with long-term use (>1 year, higher cumulative doses), based on epidemiological data, leading to its withdrawal in France and Germany and label warnings in other countries. Lactic acidosis is characteristic of biguanides (metformin); rosiglitazone (not pioglitazone) had concerns with myocardial infarction risk. Troglitazone (withdrawn) caused hepatotoxicity.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.