Troglitazone. Is it all over?

• Published in: Netherlands journal of medicine Vol. 55; no. 1; p. 4
• Main Authors: Wagenaar, L J, Kuck, E M, Hoekstra, J B
• Format: Journal Article
• Language: English
• Published: Netherlands 01-07-1999
• Subjects: Animals; Blood Glucose - drug effects; Chemical and Drug Induced Liver Injury; Chromans - adverse effects; Chromans - pharmacology; Chromans - therapeutic use; Diabetes Mellitus, Type 2 - drug therapy; Drug Therapy, Combination; Female; Humans; Hypertriglyceridemia - drug therapy; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Insulin Resistance; Liver Function Tests; Male; Thiazoles - adverse effects; Thiazoles - pharmacology; Thiazoles - therapeutic use; Thiazolidinediones
• ISSN: 0300-2977
• DOI: 10.1016/S0300-2977(99)00021-2

In January 1997 a drug from a new pharmacological class, the thiazolidinediones, became available: troglitazone. Troglitazone indirectly enhances peripheral insulin sensitivity. In this way it lowers the levels of both glucose and insulin. Troglitazone also has a lowering effect on the levels of triglycerides. In clinical trials only mild side effects had been observed. Therefore, troglitazone seemed a promising drug. Recently, however, it became clear that troglitazone could cause liver dysfunction in some patients. Although this side effect is reversible in most cases, six deaths have been described due to liver damage. Troglitazone was to be introduced in Europe in 1998 but registration procedures and clinical trials have been stopped because of its side effects on the liver. In the United States and Japan troglitazone is still being used, albeit with extra precautions. Troglitazone is a valuable addition to the arsenal of antidiabetic drugs for type 2 diabetes. It can be particularly useful, both as an additive and as a replacement, in patients for whom metformin is not suitable because of contraindications or side effects. The risk of severe liver dysfunction is a reason to reserve troglitazone as a second-line drug.