Medication Update


South Med J. 2002;95(1) 

In This Article


Mode of Action

Increase insulin sensitivity, decrease hepatic gluconeogenesis, and increase insulin-dependent glucose uptake into muscle. The thiazolidinediones do not increase insulin secretion.


As an adjunct to diet and exercise to improve glycemic control in type 2 diabetes as monotherapy or in combination with insulin (pioglitazone only), metformin, or a sulfonylurea.


Known hypersensitivity to the particular thiazoladinedione. Do not initiate therapy if baseline liver function tests (ie, ALT) are >2.5 times the upper limit of normal. Pregnancy Category: C.

Adverse Effects

Anemia, edema, headache, myalgia, upper respiratory tract infection, weight gain.

May decrease effectiveness of oral contraceptives.

May be taken with or without food.

Rosiglitazone (Avandia): Starting doses, 4 mg QD or 2mg BID. Usual dose range, 4-8 mg QD, in single or divided doses.

Pioglitazone (Actos): Starting doses,15-30 mg QD. Usual dose range, 30-45 mg QD.

Rosiglitazone: 2 mg, 4 mg, and 8 mg tablets.

Pioglitazone: 15 mg, 30 mg, and 45 mg tablets.

Rosiglitazone: SmithKline Beecham.

Pioglitazone: Takeda Pharmaceutical America, Inc.

Liver function monitoring should be done before starting therapy with either thiazoladinedione, and it should be done every 2 months for the first 12 months of therapy, then periodically while the patient is being treated. Thiazolidinediones should be discontinued if ALT levels remain elevated above three times the upper limit of normal. Full effects of these drugs may not be see for 8 to 12 weeks after the start of therapy.

  1. Hutchison TA, Shahan DR, Anderson ML (eds): DRUGDEX System. MICROMEDEX, Inc, Englewood, Colo. (Edition expires 12/2000)

  2. Hebel SK, Katstrup EK (eds): Drug Facts and Comparisons. St. Louis, Mo. 2001


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