[Medication of the month. Rosiglitazone (Avandia)]

Rosiglitazone (Avandia, Glaxo-SmithKline) belongs to a new family of oral hypoglycaemic agents, thiazolidinediones or glitazones. These molecules act as selective agonists of nuclear receptors (PPAR gamma) and improve insulin sensitivity. In Belgium as in all European countries, rosiglitazone is indicated for the treatment of type 2 diabetes, only in combination with another antidiabetic oral agent, in patients insufficiently controlled with metformin or a sulphonylurea at a maximal tolerated dose. In these patients, rosiglitazone, at a daily dose of 4 mg (sometimes 8 mg/day with metformin), reduces fasting glycaemia by 2-3 mmol/l and glycated haemoglobin level by about 1%. It exerts also favourable effects on some risk factors related to insulin resistance syndrome, which may contribute to improve cardiovascular prognosis of patients with type 2 diabetes. Hepatic safety of rosiglitazone seems to be good, although it is still recommended to check liver enzymes regularly. As all glitazones, rosiglitazone moderately promotes weight gain. It can also induce some fluid retention which may reveal or aggravate heart failure in at risk patients.