Cautions for thiazolidinediones use - in heart failure or with insulin

Administration of thiazolidinediones with insulin is cautioned. Rosiglitazone is not approved for use with insulin, as stated in the warning section of the package insert.^[3] When rosiglitazone is taken with insulin, the frequency of edema increases.

Recommendations and Considerations

Thiazolidinediones (eg. Actos, Avandia) may cause or exacerbate congestive heart failure in some patients.

• Initiation of these drugs in patients with established NYHA Class III or IV heart failure is contraindicated.
• After initiation of Actos, Actoplus Met, and Duetact, and after dose increases, observe patients carefully for signs and symptoms of heart failure (including excessive, rapid weight gain, dyspnea, and/or edema). 
• If these signs and symptoms develop and heart failure is confirmed, appropriate management of heart failure should be initiated.  Discontinuation or dose reduction of Actos, Actoplus Met, or Duetact should be considered.

Information for the Patient

Patients should be informed that Actos, alone or in combination with other antidiabetic agents, can cause fluid retention, which may exacerbate or lead to heart failure. 

• Patients should be asked to watch for and report to their healthcare professional any signs and symptoms of heart failure, including edema from fluid retention, shortness of breath or trouble breathing, unusually fast increase in weight, and unusual tiredness.

[Source: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124178.htm]

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