What is on the market that is comparable to Avandia?   (June 26, 2012)

I recently saw the following question:

“I have been on Avandia for the past several years, since they took Rezulin off the market. Now, they have taken Avandia off, too. What other medication is as good as these that I could be using? My doctor has put me on Januvia, but it isn't working as well as Avandia did. What is on the market that is comparable to Avandia?  Should I be asking my doctor about a combination of drugs?”

My reply:

I will divide my thoughts into several specific comments.

First of all, whether you can still take Avandia (rosiglitazone) depends where you live. Avandia, which is in a class of diabetes drugs called thiazolidinediones (which are nicknamed TZDs or glitazones) is still available on a very limited basis in the United States, although it’s off the market in some countries -- see my previous blog, Avandia is Gone. You can review the US rules about using Avandia at their website, www.avandia.com

Second, you mention that Januvia (sitagliptin) “isn’t working as well,” but you don’t give details of what you mean – the gold standard is that your A1C level comes down or stays down, and you don’t state if you’ve been on Januvia long enough to assess how well it’s controlling your A1C level. Please note, Januvia is in a different class of diabetes drugs than Avandia. Januvia is in the class which is called  DPP-4 inhibitors, and the DPP-4 inhibitors are generally considered less efficacious than the thiazolidinediones, although they’re generally considered to be safer.

Third: there is another thiazolidinedione available, Actos (pioglitazone). Actos comes with its own side effect profile, including other effects of the TZD class such as congestive heart failure and osteoporosis, but also is associated with bladder cancer, and France and Germany have withdrawn Actos from their countries – see France and Germany Withdraw Use of Actos Because of Risk of Bladder Cancer. Actos should work as well as Avandia, and be a bit safer than Avandia for heart problems, but with the flip side being that you might have more of an risk of developing bladder cancer.

Next: you asked about using combinations of diabetes drugs. This is indeed a very worthwhile consideration. For instance, you might continue using the Januvia, and add metformin, a very potent antidiabetic drug. These two drugs have been studied together, and are available in a combination pill called Janumet, or in the long-lasting version, Janumet XR. There are many other combinations of diabetes medications that have been studied, and which combination would be best to try next would be up to your physician. If you are tolerating the Januvia, I’d suggest your doctor consider keeping on it if your A1C is elevated, and be sure you’re on the maximal dose (100 mg/day); if you are, then add another diabetes medication, but which one to add would be up to your doc: Avandia has been studied with numerous other meds (the information about which other drugs have been studied is in the Januvia USPI).

Finally, you didn’t mention whether you’ve been on other diabetes drugs (except Rezulin, which was a TZD, and is no longer available). There are drugs such as metformin, and the sulfonylureas, and numerous others (see my essay, Currently Available Diabetes Drugs) and of course there's insulin, which should always be a consideration if you're not doing well on oral drugs.

Best wishes; hope this helps!