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A fourth group of medication is one that we call Thiazolidinediones
we just use the word TZD for short in order to pronounce it easier.
There are two agents made in this fashion they are called Avandia or Rosiglitazone
and Actos or pioglitazone.
These agents are a little bit different than anything else in that they work in the body to reduce
reduce insulin resistance they work on the muscle cells in the fat cells of your body
and enable them to use insulin better
and therefore reduce your blood sugar very effectively Avandia comes as a 2,4 or 8 mg tablet
and is taken once a day or sometimes twice a day.
Actos comes as a 15, 30 or 45 mg tablet and is also taken once a day.
The big thing about these two agents is that they don't cause and excessively low blood sugar
and therefore we don't really need to test their blood sugars often when we take that medicine in order to identify hypoglycemia
because it won't happen
however these agents do have some adverse effects because some fluid retention and therefore if you have heart failure
you should not take these medications
there was a question whether there was an increased incidence of heart attack actually
with Avandia but in recent studies that is not been shown to be the case even though there was an increased
incidences of heart attack in patients who had fluid retention and heart failure.
There is one other side effect of these drugs which is out of some importance of his recently been shown that
they cause a weakening of the bones or osteoporosis
they lead to fractures but it's unusual fracture site it's the bones of the feet, the hands, and the lower arms
not the spine and the hips the usual source of most osteoporosis fractures so if you had a person who has osteoporosis
they probably shouldn't take these agents
Finally I should mention these agents come combined
with metformin and with a sulfonylurea called Amarillo and therefore
Avandia is available as an Avandamet
and Avandamet is a drug combining 500 mg of metformin with 2
4 or 8 mg of Avandia
the amount of metformin in those ages could be there are 500 or 1000 mg pill so you can end up taking
one pill twice a day and have a very significant blood sugar lowering
and is used a great deal in patients who have a high A1c
that is high blood sugars and you need more than one drug to get them down
to their goal levels that's when you would consider a combined agent.
Another combination is a combination of Avandia and a sulfonylurea
Amaryl or glimepiride
Avandaryl comes as a 4 mg of Avandia
with 1 to 2 mg of Amaryl, or
4 mg of Avandia with 4 mg of Amaryl.
This combined agent taken twice a day very effectively reduces blood sugar but in this case can cause hypoglycemia
because the sulfonylurea Amaryl does produce hypoglycemia
they also can cause fluid retention and lead to some fractures in women as well.