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

Management

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