This relatively new class of drug helps combat insulin resistance by making your body more sensitive to insulin. The first thiazolidinedione was approved for sale in the U.S. in 1997. It was sold under the brand name Rezulin (troglitazone), but was pulled from the market in March 2000 due to the risk for severe liver problems.
Avandia and Actos were approved by the U.S. Food and Drug Administration in 1999.
In 2007, a study suggested that Avandia was associated with an increased risk of heart attack and heart failure, a condition in which the heart becomes enlarged and pumps inefficiently. Shortly after, another study found that Actos also boosted the risk of heart failure, although it reduced the risk of heart attack, stroke and death overall. Both studies were widely covered in the news.
"There's a concern about the link between heart disease and the use of thiazolidinediones," says Dace Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. "There's a concern that [the drugs] will cause heart failure and that's always been a known risk but it's a bit more surprising that there's a link to heart attacks. It's not clear how strong that linkage is."
Examples
| Generic Name | Brand Name |
|---|---|
| pioglitazone | Actos |
| rosiglitazone | Avandia |
| rosiglitazone and metformin | Avandamet |
Metformin is a biguanide medication. For more information, see the Medications section of the topic Type 2 Diabetes: Recently Diagnosed.
The thiazolidinedione medication troglitazone (Rezulin) has been removed from the market in the United States and some European countries. Troglitazone has been shown to cause severe liver problems in a small number of people who take it.
How It Works
The action of these medicines in treating type 2 diabetes is not completely understood. They improve the way cells in the body respond to insulin by lowering insulin resistance. Unlike some other medicines used to treat diabetes, they do not cause the pancreas to produce more insulin.
Pioglitazone may help in the treatment of high cholesterol by reducing triglycerides and increasing high-density lipoproteins (HDL) in the blood. Rosiglitazone increases high-density lipoproteins (HDL) and slightly increases low-density lipoproteins (LDL).1 If you have high LDL, this may be a factor in selecting pioglitazone over rosiglitazone. The long-term effects of thiazolidinediones on cholesterol levels and the incidence of heart disease are not known.2
Unlike pioglitazone, rosiglitazone does not interact with certain medicines, such as the antibiotic erythromycin and birth control pills.
Why It Is Used
These medicines are not recommended as the first choice to lower blood sugar levels. Thiazolidinediones should be used only when other medicines have failed to lower blood sugar levels into a safe range.
The U.S. Food and Drug Administration (FDA) recommends that rosiglitazone and pioglitazone be used alone or in combination with sulfonylurea medications, metformin, or insulin shots.
How Well It Works
Clinical studies have shown that these medicines can effectively lower blood sugar levels.1
Side Effects
Some reported side effects of thiazolidinediones include:
- Upper respiratory infections and sinusitis.
- Headaches.
- Mild anemia.
- Retention of fluid in the body. This may lead to heart failure.
- Weight gain.
- Muscle pain.
Women who take rosiglitazone (Avandia) or pioglitazone (Actos) may increase their risk for upper arm or foot fractures, according to a warning from the U.S. Food and Drug Administration.
Troglitazone (Rezulin), a thiazolidinedione that has been removed from the market in the United States and some European countries, has been shown to cause severe liver problems in a small number of people who took it. At present, the newer thiazolidinediones (rosiglitazone and pioglitazone) have not been shown to cause liver damage. But liver damage may still be a risk. Symptoms of liver damage include:
- Nausea, vomiting, and abdominal pain.
- Fatigue.
- Loss of appetite.
- Yellowing of the skin or the whites of the eyes (jaundice).
- Dark urine.
If you are taking one of these medicines and have these symptoms, report them to your doctor immediately.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
The U.S. Food and Drug Administration (FDA) has announced a possible safety issue with the drug rosiglitazone (Avandia). A new study shows that people who take Avandia may raise their chance of having a heart attack. They may also raise their chance of death from heart disease.
If you take Avandia, do not stop taking the medicine. Call your doctor to talk about which medicine is best for you.
People who have heart failure or are at risk for it should not use these medicines. Talk to your doctor about whether you should take these medicines. Call your doctor immediately if you notice a sudden increase in your weight or experience shortness of breath or other symptoms of heart failure.
People with liver disease should not take thiazolidinediones. Children also should not take these medicines because of the risk of developing liver problems. If you are taking rosiglitazone or pioglitazone, you need to have blood tests before starting the medicine, then every 2 months during the first year, and periodically thereafter to make sure your liver is not being damaged. If blood test results show liver damage, you will have to stop taking the medicine.
Talk with your doctor if you want to become pregnant or are pregnant and are taking one of these medicines. You may be given another medicine because the use of these medicines during pregnancy has not been studied.
Women who have stopped menstruating before they start taking these medicines may begin menstruating again and may become pregnant.
If you are taking this medicine along with insulin or a sulfonylurea, which causes the pancreas to produce more insulin, you may need to take a lower dose of the insulin or sulfonylurea to prevent low blood sugar (hypoglycemia).
Complete the new medication information form (PDF) 
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References
Citations
Lebowitz HE (2005). Management of hyperglycemia with oral antihyperglycemic agents in type 2 diabetes. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 687–710. Philadelphia: Lippincott Williams and Wilkins.
American Diabetes Association (2004). Dyslipidemia management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S68–S71.
Last Updated: June 16, 2008 