Rosiglitazone

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Supplement Your Prescription: What Your Doctor Doesn't Know About Nutrition Hyla Cass, M.D. See book keywords and concepts

Actos), pioglitazone and glimepride (Duetact), rosiglitazone (Avandia), rosiglitazone and glimepiride (Avandaryl), and rosiglitazone and metformin (Avandamet) This is another class of drugs used to control blood sugar. They are usually second- or third-line treatments, used in combination with metformin or sulfonylureas—or with both. Actions: Thiazolidinediones can be described as insulin sensitizers— medications that promote better insulin sensitivity.

Actos), pioglitazone and glimepride (Duetact), rosiglitazone (Avandia), rosiglitazone and glimepiride (Avandaryl), and rosiglitazone and metformin (Avandamet) This is another class of drugs used to control blood sugar. They are usually second- or third-line treatments, used in combination with metformin or sulfonylureas—or with both. Actions: Thiazolidinediones can be described as insulin sensitizers?medications that promote better insulin sensitivity.

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Rosiglitazone, however, caused more heart failure than glyburide and was associated with more weight gain (+10.6 lb vs. -6.4 lb for metformin) and fluid buildup, or edema (the probable cause of the heart failure). Twenty-two rosiglitazone patients developed heart failure, compared to nineteen with metformin and nine with glyburide.

For instance, in the A Diabetes Outcome Progression Trial (ADOPT)4 4,360 patients with poorly controlled type 2 diabetes were randomly assigned to four years of treatment with rosiglitazone, metformin, or glyburide. Compared to metformin, rosiglitazone had only a minimal increase in the number of patients who maintained glucose control at four years (40% vs. 36%), results that, although statistically significant, were described as "not clinically significant" in a commentary on the article.

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In February of that year, the manufacturers of Avandia (rosi-glitazone) reported that in their study of more than 4,300 patients with type 2 diabetes, significantly more women who took rosiglitazone experienced fractures of the foot, hand, or upper arm than did women who were taking metformin or glyburide. More research into this complication is ongoing, but results are not expected until 2009. On May 21, 2007, the Food and Drug Administration issued a news release in which it stated that rosiglitazone was associated with an increased risk of heart attack and other heart-related conditions.

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METFORMIN, METFORMIN PLUS ROSIGLITAZONE (met-FOR-min, roe-si-GLI-tuh-zohn) Brand Names: Metformin: Glucophage, Glucophage XR Metformin plus rosiglitazone: Apo-Metformin, Avandamet, Glycon, Gen-Metformin, Nu-Metformin, Novo-Metformin About Metformin, Metformin plus Rosiglitazone Diabetes is bad news for the body. But luckily, during the past several decades, more effective medicines have been developed to combat this disease. There are now five different groups of medicines that can be taken orally.

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Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. Engl J Med 2W7 May 21. No authors listed. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: Results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet 2000 Jan 22; 355 (9200):253-59. Ryan AS et al. Hormone replacement therapy, insulin sensitivity, and abdominal obesity in postmenopausal women. Diabetes Care 2002 Jan; 25(1): 127-33. Soulis-Liparota T et al.

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Twenty-two rosiglitazone patients developed heart failure, compared to nineteen with metformin and nine with glyburide. In the PROspective pioglitAzone Clinical Trial In macro Vascular Events (PROactive) Study,5 5,238 patients with type 2 diabetes and evidence of vascular disease were randomly assigned to treatment with pioglitazone or placebo as part of their typical treatment regimen.

After the withdrawal of troglitazone because of its liver toxicity, piogli-tazone (Actos) and rosiglitazone (Avandia) were the only glitazones used for treating patients with type 2 diabetes, either alone or in combination with metformin or with sulfonylureas. Avandamet is a combination of rosi-glitazone and metformin. Many doctors use glitazones in combination with insulin, which improves glucose control while decreasing the amount of insulin required.

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Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med 2006 Dec 7; 355(23):2427-43. Kapoor D et al. Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hyper-cholesterolaemia in hypogonadal men with type 2 diabetes. Eur J Endocrinol 2006 Jun; 154(6):899-906. Kilhovd BK et al. Angiotensin-converting enzyme inhibition influences serum levels of advanced glycation end products in patients with coronary artery disease: Results from a HOPE substudy. Heart Drug 2003; 3:67-72. Koro CE et al.

On May 21, 2007, the Food and Drug Administration issued a news release in which it stated that rosiglitazone was associated with an increased risk of heart attack and other heart-related conditions. The related article published in the New England Journal of Medicine reported that the risks were 43 percent for heart failure and 64 percent for death from cardiovascular causes. Insulins For people who have type 1 diabetes, insulin is a life-saving medication that must be taken every day.

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Although it's not completely clear how these drugs work, metformin appears to: • Help clear blood sugar (glucose) from the blood • Slow the production of new glucose in the liver • Reduce the absorption of glucose from the gastrointestinal tract It's very common for physicians to give patients two different drugs to combat diabetes, and metformin may be combined with the medication rosiglitazone. rosiglitazone combats diabetes in several ways, chief of which is to reduce insulin resistance.

Insulin resistance arises when the cells responsible for storing excess blood sugar refuse to "open up" when insulin comes knocking at the door. rosiglitazone acts like a key, helping insulin open the door, so it can deposit the excess glucose inside the cell and clear it from the blood. Possible Side Effects Metformin's more common side effects include nausea, diarrhea, flatulence, and weakness. The more common side effects seen with metformin plus rosiglitazone include upper respiratory tract infection and diarrhea.

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Rosiglitazone (Avandia) is a drug sometimes prescribed for type 2 diabetes. This drug controls blood sugar by adjusting the sensitivity of fat and muscle tissue to the insulin in the body. Q Trials of a promising new diabetes vaccine, produced by Clinalfa, a subsidiary of Merck, are undeway. The vaccine contains a molecule that is similar to a part of the insulin-producing cells in the pancreas. This molecule, when added to human blood, forms a protective barrier against the white blood cells that typically destroy the insulin-producing cells.

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A competing drug, rosiglitazone (Avandia, Avan-damet), has also been linked to fluid retention. More worrisome, though, is the possibility that this drug may contribute to fluid accumulation in the back of the eye. This macular edema could lead to blurred vision and eye damage. Repaglinide (Prandin) The goal of treating diabetes is to keep blood sugar within the normal range, because that reduces the likelihood of serious complications.

Oncaspar) pentamidine prednisolone prednisone ritodrine (Yutopar) rituximab (Rituxin) rosiglitazone (Avandia) salmeterol (Serevent Diskus) saquinavir (Invirase) sargramostim (Leukine) sirolimus (Rapamune) sotalol (Coreg) tacrolimus (Prograf) tenofovir (Viread) terbutaline testosterone (AndroGel) tiotropium (Spiriva HandiHaler) torsemide (Demadex) triamcinalone triamterene + hydrochlorothiazide (Dyazide, Maxzide) valganciclovir (Valcyte) take one of them, do not stop the medication on your own. Discuss your concerns with your physician.

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The more common side effects seen with metformin plus rosiglitazone include upper respiratory tract infection and diarrhea. Which Nutrients Are Robbed Taking this medicine may deplete your supply of, increase your need for, or interfere with the activity of: • Folic acid • Vitamin B12 Additional Ways These Drugs May Upset Your Nutritional Balance Metformin can cause low blood sugar (hypoglycemia), nausea, vomiting, indigestion, abdominal discomfort and distention, heartburn, and changes in taste, all of which can upset your eating habits and possibly interfere with good nutrition.

Metformin plus rosiglitazone can interfere with good nutrition by causing hypoglycemia and diarrhea. Restoring Your Nutritional Balance To compensate for the nutrient loss caused by this drug, speak to your physician about taking 400-800 meg folic acid and 500—1,000 meg vitamin B12 per day.

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Common prescription medications used specifically to treat type 2 diabetes include sulfonylureas, such as glipizide (Glucotrol, Glucotrol XL), glimepiride (Amaryl), and glyburide (DiaBeta, Mi-cronase, Glynase PresTab); the biguanide metformin (Glucophage); the meglitinide repaglinide (Prandin); and thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone (Actos). Injectable glucagon (Glucagon Emergency Kit) is used to treat severe hypoglycemia resulting from insulin overdose.

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STATINS Diabetics are most definitely at an increased risk for heart disease. This increased risk has led the American Heart Association and the National Cholesterol Education Panel of the National Institutes of Health to call them "heart-disease equivalents," a label that has been used to justify a push for more treatment of diabetics with statins for the prevention of heart attacks as well as their recurrence in diabetics with a history of heart disease. But just because they have a greater risk of heart attacks doesn't mean they will get extra benefit from taking cholesterol-lowering drugs.

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Trade names are Glucotrol (glipizide); Micronase, Glynase, and DiaBeta (glyburide); Amaryl (glimepiride); Glucovance (a combination of metformin and glyburide); Avandamet (a combination of metformin and rosiglitazone); Starlix (nateglinide); and Prandin (repaglinide). "How does this work?" you may ask. How can you lose weight if you are paying no attention at all to portion sizes, calories, and carbohydrates? There are three main reasons. First, the foods have very little fat, so you are eliminating the main source of unwanted calories.

Dangerous hypoglycemia is very unlikely if you are on no medications, and it is also unlikely if you are being treated with only metformin (Glucophage) or a thiazolidinedione, such as pioglitazone (Actos) or rosiglitazone (Avandia). However, hypoglycemia is likely to occur if you take any of the following drugs. þInsulin (any injected, pump, or inhaled form) þGlyburide (Micronase, Glynase, DiaBeta, or the combination drug Glucovance) þGlipizide (Glucotrol) þGlimepiride (Amaryl) þNateglinide (Starlix) þRepaglinide (Prandin) This is just a short list of medications that may put you at risk.

Pioglitazone (Actos) and rosiglitazone (Avandia) increase insulin sensitivity and decrease the liver's production of glucose. They are in the chemical category called thiazolidinediones. They can cause weight gain and fluid retention, but when taken alone, they do not cause low blood sugar. Acarbose (Precose) and miglitol (Glyset) block the enzymes that digest carbohydrate in the intestinal tract and reduce the body's absorption of glucose. Gas and diarrhea are common side effects.

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Risk category C for pioglitazone and rosiglitazone (see page xviii). Breast-feeding: It is unknown if drug passes into milk. It is not recommended for use in nursing mothers. Infants & children: Safety and efficacy have not been established. Use only under close medical supervision. Prolonged use: • Schedule regular doctor visits to determine if the drug is continuing to be effective in controlling the diabetes and to check for any liver function problems. • You will most likely require an antidiabetic medicine for the rest of your life.

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