TZD-Avandia

Drug - Thiazolidinedinones (TZDs)

December 2007

Therapeutic area - Diabetes

Preferred - No PA required	Nonpreferred
Actos 15 mg, 30 mg, 45 mg	Avandia 2 mg, 4 mg, 8 mg

Criteria

Patient does not have heart failure
Patient does not have moderate to severe hepatic function impairment
The recipient has failed a trial of Actos, defined as a lack of efficacy or presence of significant side-effects
A patient must have had a 12 week trial of Actos before ineffectiveness can be documented

Increased weight gain or fluid retention is expected of either drug, but may constitute a definition of failure. It is possible that a patient will have different fluid-retention responses to the two TZDs. Patients with heart failure should not take either TZD or any combination with a TZD.

Authorization will not be granted if failure is defined as:

Ovulation that has resumed in premenopausal anovulatory patients

Neither of these drugs should be approved for use in patients who have:

Polycystic ovarian syndrome OR
Werner syndrome

Exceptions

See Grandfathering Criteria – which indicate patient specific criteria that would exclude a patient from switching to a preferred drug

Other notes

Actos is associated with mean decreases in triglycerides and increases in HDL
Avandia is associated with mean increases in total cholesterol, LDL, HDL
TZD use is not recommended in patients with moderate to severe hepatic function impairment
Avandia and Actos are contraindicated in NYHA class III and IV

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411