Zolid

Introduction

Zolid contains pioglitazone, an insulin-sensitizing medicine used in type 2 diabetes when diet and exercise alone are not enough. It improves the body’s response to its own insulin rather than forcing the pancreas to release more. In Pakistan it is commonly paired with other oral agents when metformin is not suitable or when control remains suboptimal.

Primary Uses

Zolid is used as an adjunct to diet and exercise in adults with type 2 diabetes:

• Monotherapy: when metformin is inappropriate due to contraindications or intolerance, particularly in overweight patients.

• Dual oral therapy:

  • With metformin when maximal tolerated metformin alone does not achieve control.

  • With a sulphonylurea when metformin is contraindicated or not tolerated and control with sulphonylurea alone is inadequate.

• Triple oral therapy: with metformin + a sulphonylurea when dual therapy fails to achieve targets.

• Combination with insulin: for patients insufficiently controlled on insulin for whom metformin is inappropriate.

How It Works

Pioglitazone activates PPAR-gamma receptors in fat, muscle, and liver. This increases insulin sensitivity, enhances glucose uptake in peripheral tissues, and reduces hepatic glucose output. The result is smoother fasting and post-meal glucose without stimulating insulin secretion.

Side Effects

• Weight gain, fluid retention, ankle swelling.

• Hypoglycemia when used with insulin or sulphonylureas.

• Upper respiratory symptoms, headache, dizziness.

• Decreased hemoglobin or hematocrit (dilutional).

• Bone fracture risk increased, especially in women with long-term use.

• Visual changes from macular edema (uncommon).

• Liver enzyme elevations (rare).

Stop and seek medical advice if sudden shortness of breath, rapid weight gain, or swelling suggest heart failure.

When Not to Use

• Heart failure or history of heart failure (especially NYHA class III–IV).

• Active liver disease or persistent, unexplained elevation of transaminases.

• Diabetic ketoacidosis.

• Active bladder cancer or history of bladder cancer, or unexplained hematuria pending evaluation.

• Known hypersensitivity to pioglitazone or excipients.

Precautions & Warnings

• Risk of fluid retention and heart failure rises with concomitant insulin; monitor for edema and dyspnea.

• Consider bone health assessment in women and older adults; fracture risk increases with duration.

• Monitor ALT/AST before initiation and periodically thereafter; discontinue if persistent elevations occur.

• Use with caution in renal impairment when combined with insulin or sulphonylureas due to hypoglycemia risk.

• Reports of macular edema; advise patients to report visual changes.

• Weight gain is usually dose-related and partly fluid; distinguish from edema.

Drug Interactions

• Insulin, sulphonylureas: additive glucose-lowering, higher hypoglycemia and edema risk.

• CYP2C8 inhibitors (e.g., gemfibrozil) may increase pioglitazone exposure; dose adjustment may be considered by the prescriber.

• CYP2C8 inducers (e.g., rifampicin) may reduce exposure and effect.

• Concomitant diuretics, NSAIDs, or drugs affecting fluid balance may influence edema risk.

Dosing Notes

(Reference outline only; follow the prescriber’s instructions.)

• Taken once daily, with or without food.

• Strengths commonly available: 15 mg, 30 mg; the prescriber selects dose based on response and tolerability.

• Glucose monitoring guides any titration and combination adjustments.

Doctor’s Overview

Dr. Sana Qureshi, Endocrinology (Lahore):
“Pioglitazone improves insulin sensitivity and helps flatten day-to-day glucose variability. It’s often considered when metformin cannot be used, or as part of dual or triple therapy. Monitoring for fluid retention, weight change, liver enzymes, and bone health is part of routine follow-up.”

Storage

• Store at room temperature, protected from heat, moisture, and direct light.

• Keep in original packaging and out of reach of children.

Disclaimer

This profile provides general medical information for awareness and does not constitute a prescription or individualized advice. Always follow the guidance of a registered healthcare professional for diagnosis, dosing, and treatment decisions.