Generic Name

Troglitazone

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Classification

FDA Approved Indications

• Type 2 diabetes mellitus, as an adjunct to diet and exercise

Mechanism of Action

Troglitazone activates peroxisome proliferator-activated receptor gamma (PPARγ), which modulates insulin sensitivity in muscle and adipose tissue, resulting in increased glucose uptake and decreased hepatic glucose production.

Dosage and Administration

Adult: Initially 200 mg daily in divided doses; dosage may be adjusted based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower doses due to potential for increased side effects.

Renal Impairment: Adjust dose only if necessary; no specific guidelines.

Hepatic Impairment: Contraindicated in patients with active liver disease or elevated liver enzymes.

Pharmacokinetics

Absorption: Well absorbed from the gastrointestinal tract.

Distribution: Widely distributed; crosses the blood-brain barrier.

Metabolism: Metabolized extensively in the liver via glucuronidation and oxidation.

Excretion: Excreted primarily in the feces, with some in urine.

Half Life: Approximately 5 hours.

Contraindications

• Active liver disease or unexplained hepatic dysfunction.
• History of adverse hepatic reactions related to Troglitazone.

Precautions

• Liver function tests should be monitored before starting therapy and periodically during treatment.
• Use with caution in patients with heart failure, as fluid retention can occur.

Adverse Reactions - Common

• Nausea (Common)
• Weight gain (Common)
• Sinusitis (Common)

Adverse Reactions - Serious

• Hepatic failure (Rare but serious; can be fatal)
• Heart failure exacerbation (Rare)

Drug-Drug Interactions

• Other hepatotoxic drugs (e.g., certain antibiotics, antifungals) may increase risk of liver toxicity.
• CYP450 enzyme inducers or inhibitors can alter metabolism.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report any symptoms of jaundice, dark urine, or abdominal pain.
• Advise on importance of regular liver function monitoring.
• Encourage healthy diet and adherence to medication.

Special Considerations

Black Box Warnings:

• Severe, potentially fatal hepatic failure has been reported; contraindicated in patients with active liver disease.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Nausea, vomiting, abdominal pain, jaundice, hepatic failure signs.

Treatment: Discontinue drug immediately; supportive care; monitor liver function; consider hospitalization.

Storage and Handling

Storage: Store at room temperature, away from moisture and heat.

Stability: Stable under normal conditions; follow manufacturer recommendations.