PCDS notes the Europe-wide withdrawal of rosiglitazone in all formulations (Avandia® and Avandamet® in the UK). Prescribers should no longer prescribe rosiglitazone in any formulation either as an acute item or as a repeat prescription. PCDS suggests that rosiglitazone prescriptions be changed at the earliest time convenient to the person with type 2 diabetes, but preferably within the next 2 months.
For people with well-controlled diabetes and without evident heart failure or significant risk of fracture, a direct switch to pioglitazone (Actos®) – 4 mg rosiglitazone to 30 mg pioglitazone, or 8 mg rosiglitazone to 45 mg pioglitazone – would be appropriate. There are three formulations of the combination product Avandamet®: 2 mg rosiglitazone with either 500 mg or 1 g metformin, and 4 mg rosiglitazone with 1 g metformin. There is, however, only one preparation of pioglitazone with metformin (Competact®): 15 mg pioglitazone with 850 mg metformin. Table 1 gives some advice on changing Avandamet® to Competact® in those people whose type 2 diabetes is well controlled and without contraindications to the use of a thiazolidinedione (TZD). Please remember that such a change of medication has the potential to increase the risk of hypoglycaemic episodes.
For those not well controlled with TZDs, or with relative contraindications to TZDs, this time should be used as an opportunity to review overall care and consider other therapeutic options in accordance with the NICE guidelines (National Collaborating Centre for Chronic Conditions, 2008).
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