Thiazolidinediones are a class of oral agents used in non-insulin dependent Type II diabetes mellitus.


Mechanism of action: insulin sensitization (reduced insulin resistance) in muscle, liver and adipose tissue


Types of thiazolidinediones:

(1) rosiglitazone (Avandia; no longer recommended as of 2008)

(2) pioglitazone (Actos)

(3) troglitazone (no longer available)



(1) liver disease (active and/or elevated liver function tests (ALT > 2.5 times the upper limit of the normal reference range)

(2) congestive heart failure, NYHA Class III or IV

(3) marked edema or worsening edema (relative contraindication, related to fluid retention)

(4) for rosiglitazone, concurrent therapy with insulin can result in hypoglycemia




enhanced fertility in a premenopausal woman with one or both ovaries (related to increased ovulation)

contraception may be necessary if pregnancy not desired


mild to moderate levels may respond to diuretics or a reduced thiazolidinedione dose

worsening of lipid profile

start or adjust antilipid agents


No dose adjustment is needed with renal impairment.



(1) liver function tests

(2) body weight and signs of edema

(3) blood glucose and hemoglobin A1c

(4) serum lipids


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