Pioglitazone tablet found risky for diabetic patients abroad while MoH claims it’s safe in Bhutan

The medication drug being prescribed to treat diabetes, ‘Pioglitazone’ tablet, which is included under the national essential drugs list, is found to increase the risk of bladder cancer in patients who are exposed to the drug.

This is what the Drug Regulatory Authority (DRA) through a letter on the regulatory information on the tablet for the safety measures for the diabetes medication informed the Ministry of Health (MoH).

The MoH letter dated on September 25 states, “The result of epidemiological study in developed countries showed increase risk of bladder cancer in patients exposed to Pioglitazone and showed tendency that more cumulative dose and long duration of administration increased the risk of bladder cancer.”

It further notifies, “All the prescribers are requested not to use Pioglitazone in patients with active bladder cancer. The physicians and prescribers are also advised to inform the patients on the risk and should ensure that urine tests are performed periodically for the signs of haematurea and other related symptoms for those patients using Pioglitazone for longer duration.”

MoH’s Director General under Department of Medical Services Dr Ugen Dophu said, “It is safe here in our hospital and Pioglitazone tablet is not given to all our patients”. He said it is hardly prescribed and given only to a few patients.

“This is not a problem here because JDWNRH do not use more often, rather our patients are exposed to other safe anti-diabetic medication,” he said.  Dr Dophu said the majority of patients in Bhutan are treated with other different types of medication.

The sale of Pioglitazone tablet is also allowed in the market in Thimphu at Nu 75 per strip.

Some of the pharmacists in the capital said they have the tablets in stock and sell only under prescription by medical authorities.

An employee of Kuenphen Pharmacy said many diabetic patients come to her pharmacy for the diabetes medication on the daily basis, which includes patients prescribed with Pioglitazone tablet.

She also added that she wasn’t aware of such information on the negative aspects of the drug as there wasn’t any notice or warning from concerned agencies, and that the tablet is sold on a daily basis as and when prescribed by the hospital.

She said, “Most of the patients are not so familiar with the medicines being prescribed and people come here with prescriptions because it is more convenient.”

The JDWNR hospital sees diabetic patient every Tuesday and Thursday, also called the Diabetic Clinic Day. The medical specialist with the hospital said the hospital provides services to about 70 diabetic patients in a day.

The medical specialist said normally Pioglitazone is prescribed, but only as an add-on medication when other medicines do not work.

Diabetes, a lifelong disease is one of the most expensive diseases to be treated and if left untreated can lead to serious health problems such as heart disease, blindness, high blood pressure, kidney failure, and nerve damage among many others.

It is also said people with diabetes are more susceptible to illnesses and have worse prognosis.

Looking at the pattern of diabetic patients in the country, according to Annual Health Bulletin 2013, the number of diabetes patients seen for last five years was increasing in number every year. About 2,541 cases were seen in 2008, while it increased to 2, 605 in 2009, 3,275 in 2011, and 4, 097 cases seen in 2012.

While mortality report from health facility shows 21 in 2010, the number later increased to 30 in 2011.

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