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Monthly Diabetes Care Topic

February 2008: Avandia

Written By: Dr. Saudek

There has been a lot in the news lately about heart disease and rosiglitazone (Avandia, which is also marketed as a combination with metformin  as Avandamet).  Here’s my take on the topic:

Avandia has been widely used, and this specific question just came to light over the past six months.  The other available drug in its class, pioglitazone (Actos) has not been implicated.  We are dealing first, then, with what are the “class effects” of these two pills, and what are the effects that apply only to one or the other.

The side effects that apply to both Avandia and Actos are fluid retention and weight gain.  These side effects do not happen in everyone, but they are worth looking out for.  If you suddenly develop ankle swelling, for instance, on either Avandia or Actos, you may want to mention it to your health care professional. Rarely, this fluid retention can actually cause congestive heart failure, so if in the past you have had heart failure you probably should not be taking either drug.  Second, if you gain significant weight, if the effort to diet just doesn’t seem to be working, you may again be having a known side effect of either Avandia or Actos. 

What about heart attacks?  There are 3 articles that have now found that there is a slightly increased risk of heart attacks—one in the New England Journal of Medicine on June 14, Journal of the American Medical Association (JAMA) on September 12 and December 12.  One in JAMA on September 12 specifically found Actos to have fewer heart attacks. 

So in conclusion, both drugs have been fairly effective in treating type 2 diabetes.  The evidence now is that either drug can cause some fluid retention and weight gain.  Avandia specifically is associated with a slightly higher risk of heart attacks, while Actos is not.