recommendations for prescribing thiazolidinediones (glitazones, TZDs) from the American Diabetic Association and the American Heart Association

Management: 1) before starting a TZD, review history & perform physical examination for indications of heart disease 2) instruct patients to report new edema or dyspnea promptly 3) start with low TZD doses & increase slowly in patients with a) multiple CHF risk factors b) abnormal, but asymptomatic ventricular function, or c) NYHA class 1 or 2 heart failure 4) do NOT use TZDs in patients with NYHA class 3 or 4 heart failure 5) if edema develops during TZD therapy & heart failure is excluded as the cause a) diuretic can be considered while continuing the TZD b) reducing the TZD dosage or discontinuing it may be better 6) if a new diagnosis of CHF is made during TZD therapy, re-evaluate the choice of TZD therapy 7) if CHF develops in a patient with known left ventricular dysfunction, the drug should be stopped

References

- Nesto RW et al Thiazolidinedione use, fluid retention, and congestive heart failure: a consensus statement from the American Heart Association and American Diabetes Association. October 7, 2003. Circulation 108:2941, 2003 PMID: 14662691 http://circ.ahajournals.org/cgi/content/full/108/23/2941