Thiazolidinediones (TZDs) increase insulin sensitivity by activating the PPAR-gamma. This activates a number of genes that play a role in glucose metabolism and results in a reduction in blood glucose.
Topics in development
- Therapeutic Considerations
- Dosing Considerations
- Brand Considerations
- Actos (pioglitazone)
- Avandia (rosiglitazone)
Related:
- Diabetes Canada does not have a patient handout for this class of medication
- Complete Diabetes Medication Table: Thiazolidinediones (TZDs)
1. Therapeutic Considerations
All information from medication product monograph unless referenced below.
| A1c Lowering | 1-1.5%1 |
| Hypoglycemia Risk | Low |
| Class Side Effects | Fluid retention (increased risk of heart failure), decreased bone density, increase in non-fatal MI (rosiglitazone). |
| Vascular Protection | No |
| Renal Protection | No |
| Heart Failure Hospitalization Protection | No |
| Weight | Increase |
| Cost, Blue Cross coverage; strengths; dosing frequency; indications |
Click to visit TZDs in the Complete Diabetes Medications Table |
| Combination Medications | Combinations no longer available in Canada. |
| Advice for times of dehydration, vomiting, diarrhea | Diabetes Canada advises to take this medication as directed unless otherwise directed by a healthcare provider. |
| Other |
|
2. Dosing Considerations
- Refer to Therapeutic Considerations for Renal Impairment, Diabetes Canada for renal dosing recommendations.
- Requires 6-12 weeks for full glucose lowering effect.
- Dose increased as indicated below for specific brands based on overall glucose levels and/or A1c level.
3. Brand Considerations
Pioglitazone - Actos
- See the Complete Diabetes Medication Table for: cost/month; Blue Cross coverage; available strengths; dosing frequency; Health Canada indications.
- Usual starting dose is 15 mg or 30 mg once daily. May be taken with or without food. May be increased in increments of 15 mg to maximum dose of 45 mg once daily.
Rosiglitazone - Avandia
- See the Complete Diabetes Medication Table for: cost/month; Blue Cross coverage; available strengths; dosing frequency; Health Canada indications.
- Usual starting dose is 4 mg either once daily or twice a day in divided doses. May be taken with or without food. Dose should not exceed 4 mg/day if patient is also on a sulfonylurea. If not on sulfonylurea, dose can be increased to 8 mg/day in 8-12 weeks.
References:
1. Inzucchi SE, Bergenstal RM, Buse JB, det al. Management of hyperglycemia in type 2 diabetes: a patient-centred approach. Diabetes Care 2012; 35: 1364-79. http://care.diabetesjournals.org/content/35/6/1364 (Accessed Feb 26, 2018).