Pioglitazone heart failure — GPhC CRA MCQ
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Correct answer: C — Withhold pioglitazone and urgently query symptomatic heart failure
Withhold pioglitazone and urgently query symptomatic heart failure: Pioglitazone causes fluid retention and is contraindicated in current or previous heart failure; worsening oedema and breathlessness need clinical assessment before any supply. Supply low-dose pioglitazone and add a diuretic if weight rises: Adding a diuretic does not neutralise a contraindicated thiazolidinedione in symptomatic heart failure. Defer one week and restart pioglitazone after oedema improves: Transient symptom improvement would not remove the underlying heart-failure contraindication. Supply pioglitazone with daily weights and a two-week review: Monitoring after exposure is inadequate when the medicine is contraindicated and symptoms are already worsening. Replace pioglitazone with another thiazolidinedione: Fluid retention and heart-failure risk are class concerns and substitution requires authorised review.
Reference: BNF: pioglitazone: https://bnf.nice.org.uk/drugs/pioglitazone/