PMID- 14678876
OWN - NLM
STAT- MEDLINE
DCOM- 20040123
LR  - 20190627
IS  - 0002-9343 (Print)
IS  - 0002-9343 (Linking)
VI  - 115 Suppl 8A
DP  - 2003 Dec 8
TI  - Considerations for management of fluid dynamic issues associated with 
      thiazolidinediones.
PG  - 111S-115S
AB  - Thiazolidinediones (TZDs) can cause weight gain and fluid retention in some 
      patients. In most cases, fluid retention is expressed as mild hemodilution. The 
      incidence of clinically evident edema is relatively uncommon. In large clinical 
      trials with rosiglitazone and pioglitazone, the frequency of edema in TZD-treated 
      patients was about 3 to 4 times higher than in placebo-treated patients. The 
      precise mechanisms responsible for weight gain, fluid retention, and edema 
      associated with TZD therapy are unclear but appear to be both dose- and 
      host-related. Weight gain is most likely multifactorial, reflecting increased 
      body fat and fluid retention. Available data are conflicting and do not 
      completely support the concept that increased body weight and decreased 
      hemoglobin/hematocrit are linked with evidence of fluid retention and 
      hemodilution. As uncommon as edema is, new-onset heart failure is even less 
      common in patients treated with a TZD. In controlled clinical trials, the 
      frequency of congestive heart failure (CHF) was identical in rosiglitazone- and 
      placebo-treated patients. The incidence of CHF is higher in patients receiving 
      combination therapy with insulin and a TZD. Patients in the insulin-treated 
      population who develop CHF tend to be older, have a longer history of type 2 
      diabetes mellitus, and have risk factors for heart failure in addition to 
      diabetes. TZDs do not necessarily require discontinuation in patients who develop 
      fluid retention or weight gain. Mild fluid retention can be treated by decreasing 
      the TZD dose and/or adding a diuretic. Patients who are taking a TZD should be 
      monitored for signs and symptoms of CHF, including excessive weight gain, edema, 
      and dyspnea. Patients with New York Heart Association (NYHA) class I or II CHF 
      can be treated with TZDs. Therapy should be initiated at low doses and slowly 
      titrated to the lowest effective dose. If CHF worsens or becomes refractory to 
      treatment, it may be necessary to discontinue the TZD. Diagnoses of NYHA class 
      III and IV CHF were not studied in clinical trials of TZDs, and thus TZDs are not 
      recommended for patients with CHF of this severity.
FAU - Hollenberg, Norman K
AU  - Hollenberg NK
AD  - Section for Physiologic Research, Brigham and Women's Hospital, Boston, 
      Massachusetts 02115, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Am J Med
JT  - The American journal of medicine
JID - 0267200
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Thiazolidinediones)
RN  - AA68LXK93C (2,4-thiazolidinedione)
SB  - IM
MH  - Body Fluids/*drug effects/*physiology
MH  - Body Weight/drug effects
MH  - Clinical Trials as Topic
MH  - Diabetes Mellitus/drug therapy/epidemiology/physiopathology
MH  - Diabetes Mellitus, Type 2/drug therapy/epidemiology/physiopathology
MH  - Disease Management
MH  - Heart Failure/drug therapy/epidemiology/physiopathology
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Obesity
MH  - Prevalence
MH  - Renin-Angiotensin System/drug effects
MH  - Risk Factors
MH  - Thiazolidinediones/*therapeutic use
RF  - 23
EDAT- 2003/12/18 05:00
MHDA- 2004/01/24 05:00
CRDT- 2003/12/18 05:00
PHST- 2003/12/18 05:00 [pubmed]
PHST- 2004/01/24 05:00 [medline]
PHST- 2003/12/18 05:00 [entrez]
AID - S0002934303005801 [pii]
AID - 10.1016/j.amjmed.2003.09.018 [doi]
PST - ppublish
SO  - Am J Med. 2003 Dec 8;115 Suppl 8A:111S-115S. doi: 10.1016/j.amjmed.2003.09.018.