Pioglitazone and rosiglitazone may cause fluid retention and peripheral oedema, which can worsen or cause heart failure. There is evidence that the
incidence of these effects is higher when pioglitazone or rosiglitazone are combined with insulin. The
incidence of hypoglycaemia may also be increased on concurrent use.
Concurrent use need not be avoided, but some caution is warranted. It is suggested that low doses are used initially and that the combination should not be used in patients with moderate to severe heart failure. If
symptoms and signs suggest congestive heart failure, the American Heart Association and American
Diabetes