What
to expect from glitazones Other sites about safety
Avandia
Actos
Thiazolidinediones are an important new class of drug used in the treatment of Type 2 (Adult Onset, Non-Insulin dependent ) diabetes. These drugs as a class are informally called the "glitazones".
Avandia ™ ,marketed by SmithKline Beecham was released in the United States in June 1999. Actos ™, marketed by Eli Lilly and Takeda was released in July 1999 in the US.
This class of drug has a unique mechanism of action, by reducing insulin resistance at the sites of insulin action in the muscle and liver.
Uses for Avandia (rosiglitazone) which are FDA Approved ('on-label')
Avandia is approved for use by itself or with metformin (Glucophage) in persons with Type 2 diabetes who are not able to be controlled with diet and exercise alone.
Uses for Actos (pioglitazone) which are FDA Approved ('on-label')
Actos is approved for use by itself, or in combination with insulin, or with sulfonylurea drugs such as glyburide or glipizide, in persons with Type 2 diabetes who are not able to be controlled with diet and exercise alone.
What to expect from these medications.
All of them are expensive ! Be prepared for sticker shock. They may cost more than $100 per month. Many people have decided to stay on insulin because of the cost.
Avandia and Actos appear to be very well tolerated and side effects are usually minimal.
Any of these medications may cause some fluid retention or weight gain. It sometimes is severe enough that the drug is discontinued. Swelling is more common when these drugs are used in combination with insulin, and in extreme cases can cause fluid overload or congestive heart failure.
The mechanism of action for all these medications is slow. Don't expect to see quick results. Some patients see some change at 4 - 5 days, but it is often 2 weeks, and sometimes 4 - 6 weeks.
We advise most of our patients to continue the same doses of their other diabetes drugs when starting Avandia or Actos, unless we have some reason to change immediately.
If you are taking insulin, and your fasting glucose falls below 100 two days in a row, call us for a possible dose adjustment. We may be able to reduce your insulin dose. A few patients, but not a majority, are able to get off insulin.
Every patient is different! Your AMS doctor will be able to tell you which medications might work for you, and what combination of diabetes drugs may work best in your particular case. Please call us if you have any questions.
The second available thiazolidinedione is Avandia. It is felt to be a promising new product in that the initial clinical studies have not seen any evidence of liver damage. This compound is about 100 times more potent by weight than Rezulin, thus the dosage used is about 100 times less.
Despite the lack of any known liver toxicity, the FDA is recommending that liver function tests be monitored at the start of treatment and then every 2 months for the first 12 months of treatment. It is felt that this recommendation reflects a degree of caution, and is meant to insure that the liver toxicity seen with Rezulin is not a class effect of all of the thiazolidinediones.
Avandia is approved for use by itself (monotherapy) and with metformin. FDA approval for use as combination therapy with insulin, or with a sulfonylurea is pending.
Avandia appears to have many of the same benefits as Rezulin, and so far appears to have substantially less risk of any liver problems.
Avandia can cause swelling of the legs, fluid retention, and in extreme cases fluid overload (also known as congestive heart failure). Taking insulin with Avandia increases this risk. Whether you should take insulin together with Avandia to reduce your blood sugar is a decision that would need to take into account the specifics of your particular medical condition.
A typical daily dose of Avandia would be from 2mg to 8mg per day.
The newest addition to the glitazone family appears to be similar in many respects to Avandia. It has similar effectiveness, and so far no reports of serious liver problems.
Actos is approved for use by itself, with insulin, or with sulfonylurea drugs like glyburide and glipizide.
The typical daily dose is 15mg, 30mg, or 45mg per day.
Actos can cause swelling of the legs, fluid retention, and in extreme cases fluid overload (also known as congestive heart failure). Taking insulin with Actos increases this risk. Whether you should take insulin together with Actos to reduce your blood sugar is a decision that would need to take into account the specifics of your particular medical condition.
For the latest drug and safety information, please look at these web sites:
This information is presented for the exclusive use of patients of Amarillo Medical Specialists, LLP in conjunction with individual medical advice provided by one of our physicians. Others who access this information should understand that this information is general in nature, and should be interpreted with counseling from a qualified medical professional. Medicine is a rapidly changing field, sometimes changing more rapidly than we can update this web page. Please call our office to discuss any recent developments.
The fact that you may have accessed this information does not constitute a doctor-patient relationship. This information is not an advertisement for patients, and is only intended for our existing patients, in the state of Texas, who have already been examined and treated by one of our physicians, and directed to this page by our staff.
We are very sorry that, due to legal advice, we unable to respond to any inquiries by EMail from persons who are not established patients in our group.
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This page last updated: 10/23/05