Monday September 04, 2006


Q; 62 year old male admitted to ICU with shortness of breath and found to be in exacerbation of congestive heart failure (CHF). Patient has past medical history of well controlled hypertension but uncontrolled type II diabetes mellitus (DM). Patient has stable New York Heart Association (NYHA) class 1 CHF since last many years with EF of 43%, on low dose lasix and ACE inhibitors. Patient echocardiogram done in ER showed no change from his previous echo available in file done about a year ago. Patient denied any change in his BP or CHF medicines but acknowledged that his primary care physician has added a new med. to control his DM ?


A; Avandia associated exacerbation of CHF

It was well established that Thiazolidinediones group of anti-diabetic medicines {Actos (pioglitazone), Avandia (rosiglitazone)}, should not be used in severe or NYHA class 3 and 4 cardiac status but recently it has been reported with Avandia (rosiglitazone) that this group may not be safe even in class 1 NYHA. Although there may not be any changes in EF, patient may experience increased rate of CHF worsening, new or worsening edema, and new or worsening dyspnea. Rosiglitazone-treated patients were reported to require increased doses of CHF medication and hospitalization. Also, ischemic adverse events, such as myocardial infarction and angina, were also more commonly reported in the rosiglitazone vs placebo group.

FDA has also recently revised safety labeling on rosiglitazone (Avandia) to warn of the increased risk for cardiovascular (CV) events associated with their use in patients with New York Heart Association (NYHA) class 1 and 2 cardiac status.


Note: Liver enzymes should be checked prior to the initiation of therapy and every 2 months with rosiglitazone in all patients.


References: click to get article

1. Avandia - rxlist.com