What are Thiazolidinediones?

Thiazolidinediones are a group of medications first offered publicly in the late 20th century and principally used as adjunct therapy in the treatment of diabetes type 2. These medicines help the body be less resistant to insulin, which can mean that accompanying insulin therapy is used less and is more useful. Unfortunately, two of the drugs in this group of three have come under fire for grave side effects. One has been pulled from the market and the US Food and Drug Administration (FDA) is still scrutinizing another, as of 2010, as potentially too dangerous to use. For now it carries sharp warnings from the FDA about risk of heart attack.

There are three drugs that are most known as thiazolidinediones. These are Rezulin® (troglitazone), Avandia® (rosiglitazone), and Actos® (pioglitazone). Scientists are developing a few other thiazolidinediones, which are presently not approved medications. As mentioned, one of these medications, troglitazone, is already no longer in use because it had a tendency to cause a form of hepatitis or liver disease that is drug induced.

The other medication that has created significant controversy is Avandia®. There is a measurable increase in heart attack risk when this drug is taken, and patients with heart disease should not risk it. Where it is of most concern is when people are unaware of evidence of heart disease and take the drug anyway. The principal issue seems to be that all thiazolidinediones can cause some water retention, and this can overload the heart and make heart attack more likely. Avandia® remains on the market with a much more limited prescribing range.

To avoid this increased risk, people may turn to Actos® instead, which isn’t associated with higher heart attack rate, though it still may not be prescribed to those with heart disease. It should also be noted that with the two thiazolidinediones available, only about one in 20 people taking the drug get edema or fluid retention, and the risk of heart attack as a result of edema is far lower. Should edema develop, physicians usually immediately discontinue the medication. The best thing to do if this matter is of concern is to discuss it with a physician.

A few other side effects of thiazolidinediones exist. Sometimes people have elevated cholesterol, though some people may have lowered cholesterol when taking these medications. Other people experience cold or flu symptoms, cough, headaches, cramps in the muscles or weight gain. Doctors need to be consulted if people have extreme stomach cramping, vomiting, jaundice, trouble breathing or any potential symptoms of heart attack or failure.

Unrelated to diabetes treatment is the use of thiazolidinediones to correct fertility issues or gynecological problems. Though not an approved use, sometimes these medicines are employed to stimulate ovulation. They may also address problems caused by polycystic ovarian disease. Yet given the warnings associated with some of these medicines, particularly Avandia®, thiazolidinediones may not get used in this manner very often.