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Warnings & Precautions
WARNINGS
Cardiac Failure and Other Cardiac Effects: 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. Text Continues Below
Patients with New York Heart Association (NYHA) Class 3 and 4 cardiac status were not studied during the clinical trials. AVANDIA is not recommended in patients with NYHA Class 3 and 4 cardiac status. In three 26-week trials in patients with type 2 diabetes, 216 received 4 mg of AVANDIA plus insulin, 322 received 8 mg of AVANDIA plus insulin, and 338 received insulin alone. These trials included patients with long-standing diabetes and a high prevalence of pre-existing medical conditions, including peripheral neuropathy, retinopathy, ischemic heart disease, vascular disease, and congestive heart failure. In these clinical studies an increased incidence of edema, cardiac failure, and other cardiovascular adverse events was seen in patients on AVANDIA and insulin combination therapy compared to insulin and placebo. Patients who experienced cardiovascular events were on average older and had a longer duration of diabetes. These cardiovascular events were noted at both the 4 mg and 8 mg daily doses of AVANDIA. In this population, however, it was not possible to determine specific risk factors that could be used to identify all patients at risk of heart failure and other cardiovascular events on combination therapy. Three of 10 patients who developed cardiac failure on combination therapy during the double blind part of the studies had no known prior evidence of congestive heart failure, or pre-existing cardiac condition. In a double-blind study in type 2 diabetes patients with chronic renal failure (112 received 4 mg or 8 mg of AVANDIA plus insulin and 108 received insulin control), there was no difference in cardiovascular adverse events with AVANDIA in combination with insulin compared to insulin control. Page: 1 | 2 | 3 | 4 | 5 | Next >>
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