Pioglitazone can cause fluid retention, which may exacerbate or precipitate heart failure. 0000009715 00000 n Also, here too, the duration of treatment differed appreciatively—26 weeks with rosiglitazone and 16 weeks with pioglitazone. In summary, the incidence of CHF in TZD-treated patients is very low but is definitely higher in patients already treated with insulin who receive higher doses of the TZD and who have other risk factors for CHF.The peripheral edema or CHF associated with the use of the drugs would suggest that an increase in plasma volume is the main culprit, either alone or superimposed on preexisting heart disease. Patients with these symptoms should be monitored carefully, particularly in the first 3 months of TZD treatment.Review most recent ECG, if indicated. Both patients and health care providers should be cognizant of the risk of CHF when TZDs are used in patients with type 2 diabetes. �0 H��� Because people with diabetes are at increased risk for CVD and many have preexisting heart disease, the edema that sometimes accompanies the use of a TZD can be cause for concern, as it may be a harbinger or sign of congestive heart failure (CHF). Presented by Karter AJ at The American Diabetes Association and American Heart Associations’ Working Group on Glitazones and Heart Disease, July 2002, Chicago, ILEnter multiple addresses on separate lines or separate them with commas.This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.Thiazolidinedione Use, Fluid Retention, and Congestive Heart FailureThiazolidinedione Use, Fluid Retention, and Congestive Heart FailureHeart Disease: A Textbook of Cardiovascular MedicineEllenberg and Rifkin’s Diabetes Mellitus: Theory and PracticeThird Annual World Congress on the Insulin Resistance SyndromeThird Annual World Congress on the Insulin Resistance Syndrome WARNING: CONGESTIVE HEART FAILURE See full prescribing information for complete boxed warning. 0000019558 00000 n Symptoms suggestive of CHF may include orthopnea, paroxysmal nocturnal dyspnea, unexplained cough or fatigue, or pedal edema.
It is unlikely, however, that the drugs differ with regard to the risk of CHF, as they incur similar degrees of volume expansion.

�ѓh��VR���D�"�:}� /�ؕy�mi�^�E8�9n��=y ��V (Jo�W�"O��䋮V�v��\�Di�WDB�\r�mK2U�lx%E����UBX�m�,iu����μ+�M�;��`Y�Rϕ��3�������������IP;��OF�Bq)�2�%ʗ3C1/�r�e�3<2#��:R%�\Y j��T�Zeu���NZ���q�˞J�u��X(�5��ki@�72�W!�Ue�H���3�? In the U.S. placebo-controlled trials, edema occurred in 4.8% of subjects on pioglitazone monotherapy, versus 1.2% on placebo (Practitioners are most likely to see edema as a consequence of TZD therapy when either of the TZDs is used in combination with insulin. 0000010157 00000 n Published 11 December 2014 From:

Observation with gradual dose escalation is warranted to identify weight gain, edema, or an exacerbation of CHF. Delea and coworkers (In another preliminary report by Karter and coworkers (This Karter study suggests that despite the common occurrence of edema with TZDs, the excess risk of CHF attributable to the TZD itself in relative terms is very small.

0000001538 00000 n

When treating patients who have at least one risk factor for development of congestive heart failure (e.g. Regardless, there were very few serious cardiac events in the short-term clinical trial data submitted with the new drug applications for either TZD.Risk factors for CHF, such as coronary artery disease and hypertension, frequently occur in patients with diabetes (The package inserts for both rosiglitazone and pioglitazone indicate that patients with more advanced heart disease (class III or IV) were excluded in premarketing clinical trials, and hence, these drugs are not recommended in such patients. However, if present, the degree of edema should be monitored carefully during TZD administration.Determine whether the patient has any shortness of breath, particularly with exertion, that might be due to cardiac or other causes (e.g., asthma, chronic obstructive pulmonary disease, obesity) so that an adequate assessment of baseline symptoms is established. Diabetes is a chronic, progressively worsening disease associated with a variety of microvascular and macrovascular complications. Peroxisome proliferator-activated receptor- γ (PPAR γ ) agonists such as rosiglitazone and pioglitazone are used to improve insulin sensitivity in patients with diabetes mellitus.

At present, there are no guidelines on the use of TZDs in patients with diabetes who have any degree of heart disease or for those already on a TZD who develop CHF.

It is not uncommon for patients with diabetes without symptomatic heart disease to have had determinations of left ventricular function with noninvasive cardiac testing in the course of screening for coronary artery disease or as part of a preoperative evaluation for surgical procedures.
0000002616 00000 n There is a growing recognition, however, that edema can occur in patients treated with either drug. When treating patients who have at least one risk factor for development of congestive heart failure (e.g.

Pioglitazone can cause fluid retention, which may exacerbate or precipitate heart failure. 0

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