Pharmacy Diabetes

G-4.4 thiazolidinediones_glitazones-Counselling Interventions

This group of medicines are rarely used today due to the side effect profile including weight gain, peripheral oedema and increase risk of heart failure and fractures.

Thiazolidinediones should be used with caution in anyone with heart conditions.
Rosiglitazone – There is an increased risk of cardiac failure when rosiglitazone is added to treatment regimens that include insulin or sulfonylureas.
  • Annual cycle of care – Cardiac screening.
  • Diabetes MedsCheck with referral back to GP for screening.
Rosiglitazone or Pioglitazone in combination with insulin or oral hypoglycaemic agents that cause hypoglycaemia may increase the risk of low glucose levels
  • Referral for glucose monitoring
  • Referral to healthcare team for further advise on hypoglycaemia management.
  • Diabetes MedsCheck
Peripheral Oedema
Approximately 5% of patients using TZDs develop peripheral oedema. When used with other antidiabetic drugs, the risk of peripheral oedema increases to approximately 18%.
  • Immediate referral to health care team.
  • Diabetes MedsCheck for side effect profile.
Weight gain
TZD associated weight gain may result mainly from increased fat mass and fluid retention and may be in part congruent to the mechanism of action of TZD. Increases in fat mass are almost exclusively limited to subcutaneous fat.
  • Diabetes MedsCheck, with education on why weight gain is occurring.
  • Referral to healthcare team for support with healthy eating plan.
  • Cholesterol monitoring in pharmacy.
  • Diabetes MedsCheck
  • Referral to healthcare team for annual cycle of care with referral for cholesterol assessment.
Bone fractures

TZD use leads to decreased bone mineral density (BMD) and an elevated risk of fracture.

  • Monitoring for calcium and strong bones in pharmacy.
  • Referral pathways back to GP where concerns.
Bladder cancer
There is a modest but clinically significant increase in the risk of bladder cancer with pioglitazone. This risk appears to be related to cumulative dose and duration of exposure.
  • Annual cycle of care-eye check
  • Diabetes MedsCheck referral back to GP for screening.
In Combination with Sulfonylureas

Increased appetite, dizziness, vertigo, flatulence, sweating, glycosuria, proteinuria and increased lactic dehydrogenase have been reported in combination with sulfonylureas.

  • Diabetes MedsCheck due to side effect profile.


Hepatocellular dysfunction
Pioglitazone – There were reports of changes in liver enzymes post market.
  • It is recommended all individuals commenced on pioglitazone have liver enzymes checked before and during treatment.
  • Diabetes MedsCheck due to side effect profile.
Macular Oedema
Individuals with type 2 diabetes mellitus using TZDs have a higher incidence of diabetic macular oedema.
  • Referral to healthcare team for annual cycle of care-eye check.
  • Diabetes MedsCheck referral back to GP for screening.