Troglitazone. Is it all over?

In January 1997 a drug from a new pharmacological class, the thiazolidinedi ones, became available: troglitazone. Troglitazone indirectly enhances peri pheral insulin sensitivity. In this way it lowers the levels of both glucos e and insulin. Troglitazone also has a lowering effect on the levels of tri glycerides. In clinical trials only mild side effects had been observed. Th erefore, troglitazone seemed a promising drug. Recently, however, it became clear that troglitazone could cause liver dysfunction in some patients. Al though this side effect is reversible in most cases, six deaths have been d escribed due to liver damage. Troglitazone was to be introduced in Europe in 1998 but registration proced ures and clinical trials have been stopped because of its side effects on t he 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 fo r type 2 diabetes. It can be particularly useful, both as an additive and a s 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. (C) 1999 Published by Elsevier Science B.V. All rights reserved.