Contraindications & Precautions | Thiazolidinedione for Patient with Diabetes Mellitus

 

Mechanism of action: insulin sensitization (reduced insulin resistance) in muscle, liver and adipose tissue

 

Types of thiazolidinediones:

(1) rosiglitazone (Avandia; no longer recommended as of 2008)

(2) pioglitazone (Actos)

(3) troglitazone (no longer available)

 

Contraindications:

(1) liver disease (active and/or elevated liver function tests (ALT > 2.5 times the upper limit of the normal reference range)

(2) congestive heart failure, NYHA Class III or IV

(3) marked edema or worsening edema (relative contraindication, related to fluid retention)

(4) for rosiglitazone, concurrent therapy with insulin can result in hypoglycemia

 

Risk	Precaution
enhanced fertility in a premenopausal woman with one or both ovaries (related to increased ovulation)	contraception may be necessary if pregnancy not desired
edema	mild to moderate levels may respond to diuretics or a reduced thiazolidinedione dose
worsening of lipid profile	start or adjust antilipid agents

 

No dose adjustment is needed with renal impairment.

 

Monitoring:

(1) liver function tests

(2) body weight and signs of edema

(3) blood glucose and hemoglobin A1c

(4) serum lipids