Avandia

Avandia Uses, Dosage, Side Effects, Food Interaction and all others data.

Avandia, a member of the thiazolidinedione class of antidiabetic agents, improves glycemic control by improving insulin sensitivity. Avandia is a highly selective and potent agonist for the peroxisome proliferator-activated receptor gamma (PPAR-γ). In humans, PPAR receptors are found in key target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPAR-γ nuclear receptors regulates the transcription of insulinresponsive genes involved in the control of glucose production, transport, and utilization. In addition, PPAR-γ-responsive genes also participate in the regulation of fatty acid metabolism. Pharmacological studies in animal models indicate that Avandia improves sensitivity to insulin in muscle and adipose tissue and inhibits hepatic gluconeogenesis. Avandia maleate is not chemically or functionally related to the sulfonylureas, the biguanides, or the alpha glucosidase inhibitors.

When rosiglitazone is used as monotherapy, it is associated with increases in total cholesterol, LDL, and HDL. It is also associated with decreases in free fatty acids. Increases in LDL occurred primarily during the first 1 to 2 months of therapy with AVANDIA and LDL levels remained elevated above baseline throughout the trials. In contrast, HDL continued to rise over time. As a result, the LDL/HDL ratio peaked after 2 months of therapy and then appeared to decrease over time.

Avandia
Uses
Dosage
Side Effect
Precautions
Interactions
Uses during Pregnancy
Uses during Breastfeeding
Accute Overdose
Food Interaction
Half Life
Volume of Distribution
Clearance
Interaction With other Medicine
Contradiction
Storage

Trade Name	Avandia
Availability	Prescription only
Generic	Rosiglitazone
Rosiglitazone Other Names	Rosiglitazon, Rosiglitazona, Rosiglitazone, Rosiglitazonum
Related Drugs	Farxiga, metformin, Trulicity, Lantus, Victoza, Tresiba, Levemir
Weight	4mg, 2mg, , 8mg
Type	Tablet, Oral Tablet
Formula	C₁₈H₁₉N₃O₃S
Weight	Average: 357.427 Monoisotopic: 357.114712179
Protein binding	99.8% bound to plasma proteins, primarily albumin.
Groups	Approved, Investigational
Therapeutic Class	Thiazolidinedione Group
Manufacturer	Glaxosmithkline
Available Country	Pakistan, Canada, United States, Netherlands,
Last Updated:	September 19, 2023 at 7:00 am

Uses

Avandia is used

As monotherapy for glycemic control.
For use in combination with a sulfonylurea, metformin, or insulin when diet, exercise, and a single agent do not result in adequate glycemic control.
Also for use in combination with a sulfonylurea plus metformin when diet, exercise, and both agents do not result in adequate glycemic control.

Avandia is also used to associated treatment for these conditions: Type 2 Diabetes Mellitus

How Avandia works

Avandia acts as a highly selective and potent agonist at peroxisome proliferator activated receptors (PPAR) in target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPAR-gamma receptors regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In this way, rosiglitazone enhances tissue sensitivity to insulin.

Dosage

Avandia dosage

The management of antidiabetic therapy should be individualized. Avandia may be administered either at a starting dose of 4 mg as a single daily dose or divided and administered in the morning and evening. For patients who respond inadequately following 8 to 12 weeks of treatment, as determined by reduction in FPG, the dose may be increased to 8 mg daily as monotherapy or in combination with metformin, sulfonylurea, or sulfonylurea plus metformin. Avandia may be taken with or without food.

Monotherapy: The usual starting dose of Avandia is 4 mg administered either as a single dose once daily or in divided doses twice daily. In clinical trials, the 4 mg twice daily regimen resulted in the greatest reduction in FPG and HbA1c.

Combination therapy: When Avandia is added to existing therapy, the current dose(s) of the agent(s) can be continued upon initiation of Avandia therapy.

Sulfonylurea: When used in combination with sulfonylurea, the usual starting dose of Avandia is 4 mg administered as either a single dose once daily or in divided doses twice daily. If patients report hypoglycemia, the dose of the sulfonylurea should be decreased.

Metformin: The usual starting dose of Avandia in combination with metformin is 4 mg administered as either a single dose once daily or in divided doses twice daily. It is unlikely that the dose of metformin will require adjustment due to hypoglycemia during combination therapy with Avandia.

Insulin: For patients stabilized on insulin, the insulin dose should be continued upon initiation of therapy with Avandia. Avandia should be dosed at 4 mg daily. Doses of Avandia greater than 4 mg daily in combination with insulin are not currently indicated. It is recommended that the insulin dose be decreased by 10% to 25% if the patient reports hypoglycemia or if FPG concentrations decrease to less than 100 mg/dL. Further adjustments should be individualized based on glucose-lowering response.

Sulfonylurea plus metformin: The usual starting dose of Avandia in combination with a sulfonylurea plus metformin is 4 mg administered as either a single dose once daily or in divided doses twice daily. If patients report hypoglycemia, the dose of the sulfonylurea should be decreased.

Maximum Recommended Dose: The dose of Avandia should not exceed 8 mg daily, as a single dose or divided twice daily. The 8 mg daily dose has been shown to be safe and effective in clinical studies as monotherapy and in combination with metformin, sulfonylurea, or sulfonylurea plus metformin. Doses of Avandia greater than 4 mg daily in combination with insulin are not currently indicated. No dosage adjustments are required for the elderly. No dosage adjustment is necessary when Avandia is used as monotherapy in patients with renal impairment.

Side Effects

The incidence and types of adverse events reported in clinical trials of Avandia as monotherapy are similar to that of placebo. Overall, the types of adverse experiences reported when Avandia was used in combination with a sulfonylurea or metformin were similar to those during monotherapy with Avandia. Events of anemia and edema tended to be reported more frequently at higher doses, and were generally mild to moderate in severity and usually did not require discontinuation of treatment with Avandia.

Toxicity

Side effects include fluid retention, congestive heart failure (CHF), liver disease

Precaution

Due to its mechanism of action, Avandia is active only in the presence of endogenous insulin. Therefore, Avandia should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. Avandia, like other thiazolidinediones, alone or in combination with other antidiabetic agents, can cause fluid retention, which may exacerbate or lead to heart failure. Patients should be observed for signs and symptoms of heart failure. In combination with insulin, thiazolidinediones may also increase the risk of other cardiovascular adverse events. Avandia should be discontinued if any deterioration in cardiac status occurs. Avandia should be used with caution in patients with edema. Liver enzymes should be checked prior to the initiation of therapy with Avandia in all patients and periodically thereafter per the clinical judgement of the healthcare professional. Therapy with Avandia should not be initiated in patients with increased baseline liver enzyme levels (ALT >2.5X upper limit of normal).

Interaction

In vitro drug metabolism studies suggest that Avandia does not inhibit any of the major P450 enzymes at clinically relevant concentrations. A decrease in the dose of Avandia may be needed when gemfibrozil is introduced. Dosage adjustment is also required when administered with rifampin. Avandia was shown to have no clinically relevant effect on the pharmacokinetics of nifedipine and oral contraceptives.

Food Interaction

Take with or without food.

[Moderate] GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes.

Hypoglycemia most frequently occurs during acute consumption of alcohol.

Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise.

The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia.

Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion.

By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia.

Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes.

A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis.

Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan.

Alcohol should not be consumed on an empty stomach or following exercise.

Avandia Hypertension interaction

[Moderate] Thiazolidinediones can cause dose-related edema.

Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension.

Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Avandia Drug Interaction

Moderate: ciprofloxacin, insulin glargineUnknown: nifedipine, amphetamine / dextroamphetamine, zolpidem, darbepoetin alfa, aspirin, diltiazem, varenicline, carvedilol, rosuvastatin, tolterodine, diltiazem, fentanyl, tamsulosin, teriparatide, metformin, glyburide / metformin, vardenafil, metoprolol

Avandia Disease Interaction

Major: myocardial infarction, CHF, type I diabetesModerate: edema, liver disease, macular edema, premenopausal anovulation, weight gainMinor: anemia

Volume of Distribution

17.6 L [oral volume of distribution Vss/F]
13.5 L [population mean, pediatric patients]

Elimination Route

The absolute bioavailability of rosiglitazone is 99%. Peak plasma concentrations are observed about 1 hour after dosing. Administration of rosiglitazone with food resulted in no change in overall exposure (AUC), but there was an approximately 28% decrease in C_max and a delay in T_max (1.75 hours). These changes are not likely to be clinically significant; therefore, rosiglitazone may be administered with or without food. Maximum plasma concentration (Cmax) and the area under the curve (AUC) of rosiglitazone increase in a dose-proportional manner over the therapeutic dose range.

Half Life

3-4 hours (single oral dose, independent of dose)

Clearance

Oral clearance (CL) = 3.03 ± 0.87 L/hr [1 mg Fasting]
Oral CL = 2.89 ± 0.71 L/hr [2 mg Fasting]
Oral CL = 2.85 ± 0.69 L/hr [8 mg Fasting]
Oral CL = 2.97 ± 0.81 L/hr [8 mg Fed]
3.15 L/hr [Population mean, Pediatric patients]

Elimination Route

Following oral or intravenous administration of [14C]rosiglitazone maleate, approximately 64% and 23% of the dose was eliminated in the urine and in the feces, respectively.

Pregnancy & Breastfeeding use

There are no adequate and well-controlled studies in pregnant women. Avandia should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Drug-related material was detected in milk from lactating rats. It is not known whether Avandia is excreted in human milk. Because many drugs are excreted in human milk, Avandia should not be administered to a nursing woman.