Q: I am a 68 year old female patient suffering from hypertension, diabetes (NIDDM) and bronchial asthma. I am on the following drugs: Ramipril, Amlodipine, Daonil, Metformin hydrochloride, Pioglitazone, Seroflow rotocaps and Flohale Nasal Spray. I was asked to start Pioglitazone 15 mg and my HbA1C has come down from 8.4 to 6.5. Fasting Blood Sugar 60~79 ; PP Blood Sugar 140 ~160. However, when I was on Daonil and Metformin only (3 Tablets + 4 Tablets/day), my Fasting average was 160 ~180 & PP was around 220 ~250). My liver function test results after 4 months of Pioglitazone are as follows: Total bilirubin - 0.7 mg/dl; Direct bilirubin- 0.3 mg/dl; Total Protein- 6.9 gm/dl Albumin- 3.7 gm/dl; Globulin- 3.2gm/dl. Serum enzyme: SGOT - 39 IU/L (Range upto 40) SGPT - 28IU/L. Alkaline Phosphatase- 96 IU/L ( 20-130 Adult). Please advise whether pioglitazone can be used continuously as my sugar levels are in good control? Since SGOT has increased will it cause any problem? Is any change in my diabetic medication recommended?

A:One of the side effects of pioglitazone is increase in SGOT/SGPT/CPK levels and sometimes liver dysfunction. Therefore it mandatory to check liver function tests (LFTs) before starting on pioglitazone and every two months for the next 12 months i.e. 6 times. You will need to do it. Only, if the LFTs go much higher, a change of medication will be required. The slight increase in SGOT/SGPT etc is not the reason to discontinue treatment. The advantages of therapy are far more than side effects. Therefore you will need to continue to take the medicine. While you have given the trade name of glibenclamide (Daonil, a good quality product), you have not given other brand names. Please ensure that you take products of reputed manufacturers of quality medicines i.e. pioglitazone (Euglim of Zydus Cadila or Oram of Wockhardt), metformin (Glyciphage of Franco-Indian or Walaphage of Wallace), amlodipine (Amlodac of Zydus Cadila or Myodura of Wockhardt) just to give some illustrative examples. Due to poor regulatory control, there are over 17,000 pharmacy companies in India producing over 40,000 brands - more than the rest of the whole world put together. Many manufacturers do not have adequate quality control.