Thiazolidinediones (TZDs)

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.

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 CHF), decreased bone density, increase in non-fatal MI (rosiglitazone), potential risk of bladder cancer (pioglitazone) 
Vascular 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
  •  When used with insulin may increase risk of edema and congestive heart failure. The combination of TZD plus insulin is currently not approved in Canada. 
  • May increase chance of becoming pregnant in premenopausal women- effective contraception should be advised. 

2. Dosing Considerations

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).