Table 2

Characteristics of thiazolidinediones approved for use in the United States and Canada

DrugTrade nameLabeled indicationsDosage, how suppliedBoxed warnings
Pioglitazone23Actos®Type 2 diabetes monotherapy or in combination with a sulfonylurea, metformin, or insulin when diet and exercise plus the single agent do not result in adequate glycemic control.15–30 mg every day, maximum 45 mg every day; supplied as 15,30,45 mg tabletsThiazolidinediones cause or exacerbate congestive heart failure in some patients. Observe patients carefully for signs and symptoms of heart failure (including excessive, rapid weight gain, dyspnea, and/or edema). If these signs and symptoms develop, the heart failure should be managed according to the current standards of care. Furthermore, discontinuation or dose reduction must be considered.

Not recommended in patients with symptomatic heart failure. Initiation in patients with established NYHA Class III or IV heart failure is contraindicated.

May be used In combination with insulin in patients with insufficient glycaemic control on insulin for whom metformin is not tolerated or contraindicated.
Rosiglitazone24AvandiaAdjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus.4 mg every day or divided into twice a day, maximum 8 mg once a day; supplied as 2,4,8, mg tabletsThiazolidinediones cause or exacerbate congestive heart failure in some patients. Observe patients carefully for signs and symptoms of heart failure (including excessive, rapid weight gain, dyspnea, and/or edema). If these signs and symptoms develop, the heart failure should be managed according to the current standards of care. Furthermore, discontinuation or dose reduction must be considered.

Not recommended in patients with symptomatic heart failure. Initiation of Avandia in patients with established NYHA Class III or IV heart failure is contraindicated.

A meta-analysis of 42 clinical studies (mean duration 6 months: 14,237 total patients), most of which compared Avandia to placebo, showed Avandia to be associated with an increased risk of myocardial ischemic events such as angina or myocardial infarction. Three other studies (mean duration 41 months; 14,067 total patients), comparing Avandia to some other approved oral antidiabetic agents or placebo, have not confirmed or excluded this risk. In their entirety, the available data on the risk of myocardial ischemia are inconclusive.

Coadministration of Avandia and insulin is not recommended.

Abbreviations: NYHA, New York Heart Association

From: Introduction

Cover of Drug Class Review: Thiazolidinediones
Drug Class Review: Thiazolidinediones: Final Report Update 1 [Internet].
Norris SL, Carson S, Thakurta S, et al.
Portland (OR): Oregon Health & Science University; 2008 Aug.
Copyright © 2008, Oregon Health & Science University, Portland, Oregon.

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