Diabetes and Troglitazone

By editor | February 25, 2008

Troglizatone is a new oral anti-hyperglycemic agent that acts to decrease insulin resistance. Its complete action is unknown, but it is thought to stimulate the production of a protein involved in the transport of sugar through the cell mem, brane from the blood to the interior of the cell for use. It takes 3 to 6 weeks for the medicine to have much effect on the blood,glucose level and may take as much as 12 weeks for it to have its full effect. The medicine is taken with food to enhance its absorption. It can be taken with any meal but needs to be taken only once a day. It is absorbed in 2 to 3 hours and may be taken at any meal. If it is missed at the usual meal, it may be taken at the next meal. If it is missed on one day, it should not be doubled the next day. More than 85 percent of the medicine’s waste products are removed through the intestinal tract, and only a little over 3 percent is released through the urine. It is not recommended for pregnant or breast feeding women or people with severe heart disease. It is recommended for persons with Type 2 diabetes. In the future, it will be used alone or with other oral agents, but it has not yet been approved for this use. It may be used alone or with other oral anti,diabetes drugs or with insulin. A person would start with 200 mg once daily with a meal. After 2 to 4 weeks, the dose may be increased to 400 mg (usual dose) or later up to the maximum dose of 600 mg. If the person is already on insulin, it is recommended that after Rezulin is started, insulin may be decreased to 10 to 25 percent or more when fasting blood sugars are less than 120 mg/dl (7 mmol). One value of this drug is that it is remarkably free of side effects, even at maximal doses.

There has been a lot of publicity recently about this drug. Newspapers, TV, and radio have publicized the dangers, and some have petitioned the FDA to recall the medication. Most of these people are not aware of the grave dangers of diabetes so they do not balance the benefits versus the dangers. The danger that has been publicized is possible damage to the liver. There have been 33 deaths from liver disease attributed to this drug over a three,year period.

There are several million people taking the drug so the possibility of fatal liver disease is very small compared with the dangers of poor blood sugar control. All of these deaths occurred early in the use of the drug when patients were not being monitored for this problem. Indeed many of the people who developed liver disease and died had liver disease prior to taking the drug so they should not have been started on it. Since this information became available over a year ago, we have been monitoring patients carefully, and no deaths have occurred since. The liver damage from the drug is rare, and when picked up early and the drug is stopped, it is reversible. The information made public recently in the lay press was over a year old and had been corrected by the medical profession and the company. This type of late press and presenting only a year old story without check, ing on the more recent facts is irresponsible and unfair to the people who need and are doing well on the drug ( and have been monitored properly). Monitoring is by a simple blood test to measure the transaminase enzymes. These enzymes should be measured before starting the drug, monthly for the first 8 months of therapy, then every 2 months, and then at every regular doctor visit. If this is done, there is little or no danger from this drug. It is a highly effective drug and has vastly improved diabetes control in thousands of patients and should continue to be used. Be sure, though, if you are taking the drug that your doctor is monitoring your enzyme levels and that the drug is stopped if they begin to rise.


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