Avandia: Is it a safe option for diabetes treatment?

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Avandia: Is it a safe option for diabetes treatment?

A Mayo Clinic diabetes specialist answers questions about Avandia and diabetes treatment.

Photo of Maria Collazo-Clavell, M.D.
Maria Collazo-Clavell, M.D.

Safety concerns about the popular type 2 diabetes drug rosiglitazone (Avandia) first surfaced in 2007. Today, the safety of Avandia remains a hotly debated topic. Here, Maria Collazo-Clavell, M.D., an endocrinologist specializing in diabetes at Mayo Clinic, Rochester, Minn., answers common questions about Avandia and type 2 diabetes.

How does Avandia work?

Avandia is one of many oral medications designed to control blood sugar. Avandia lowers the amount of sugar in your blood by making your tissues more sensitive to insulin, a hormone that regulates the absorption of sugar into your cells. Avandia belongs to a class of drugs known as thiazolidinediones.

What's the concern about Avandia?

Avandia and other thiazolidinediones have potentially serious risks, including swelling and weight gain that leads to or worsens heart failure and rare, but potentially life-threatening, liver problems. Some studies have also associated Avandia with an increased risk of heart attack. In fact, in a study published in September 2007, Avandia approximately doubled the risk of heart failure and increased the risk of heart attack by more than 40 percent.

Today, Avandia carries a black box warning — the most serious safety warning — cautioning that the drug may cause or worsen heart failure and may potentially increase the risk of heart attack.

Some studies also suggest that long-term use of thiazolidinediones may promote bone loss and increase the risk of bone fractures, particularly of the hip and wrist.

Is it safe to take Avandia?

If Avandia is part of your diabetes treatment plan, continue taking the drug as prescribed until you have the opportunity to talk to your doctor. Although an increased risk of heart attack is nothing to take lightly, the risk isn't considered an emergency. It's much riskier to stop taking a diabetes medication on your own.

If Avandia is effectively lowering your blood sugar level and you're not at high risk of cardiovascular problems, you and your doctor may decide that it's best to continue taking the drug. If you're concerned about the potential risks of Avandia — especially if you're at high risk of heart attack or other cardiovascular problems — you and your doctor may opt to stop using Avandia.

Are there alternatives to Avandia?

Many alternatives to Avandia are available in various classes of drugs. In addition to insulin, other options may include metformin (Fortamet, Glucophage, others), glipizide (Glucotrol), exenatide (Byetta), sitagliptin phosphate (Januvia) and others.

Keep in mind that all medications have benefits and risks. For example, some diabetes medications may promote weight loss or weight gain. Others may cause nausea or low blood sugar. Sometimes liver problems are a concern.

What about other drugs in the same class as Avandia?

Actos includes a black box warning about an increased risk of heart failure. However, some studies of Actos also show possible cardiac benefits — such as lowering the risk of heart attack, stroke and death.

What's the bottom line?

Researchers will continue to study the safety and effectiveness of Avandia, as well as other diabetes medications. In the meantime, the decision about which diabetes medication is best for you depends on many factors — including your blood sugar level and the presence of any other health problems. Your doctor might even combine drugs from different classes to help you control your blood sugar in several different ways. It's also important to remember the rest of your diabetes treatment plan, including healthy eating and physical activity.

If you and your doctor decide that it's best to switch from Avandia to another diabetes medication, carefully follow your doctor's instructions. You may need to monitor your blood sugar level more frequently or take other precautions while you're adjusting to the new medication.

Last Updated: 05/24/2008
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