Home Drug Guide Rosiglitazone Maleate

Drug Guide

Generic Name

Rosiglitazone Maleate

Brand Names Avandia

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Thiazolidinedione, PPARγ agonist

FDA Approved Indications

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

Mechanism of Action

Rosiglitazone activates peroxisome proliferator-activated receptor gamma (PPARγ), which increases insulin sensitivity in adipose tissue, skeletal muscle, and the liver, thereby improving blood glucose control.

Dosage and Administration

Adult: Typically 4 mg once daily, may be increased to a maximum of 8 mg/day based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Use with caution; start at lower end of dosing range due to increased sensitivity and comorbidities.

Renal Impairment: Adjust dosage based on renal function; monitor kidney function regularly.

Hepatic Impairment: Use caution; contraindicated in severe hepatic impairment.

Pharmacokinetics

Absorption: Rapidly absorbed, peak plasma levels within 1 hour.

Distribution: Widely distributed; extensive binding to plasma proteins.

Metabolism: Metabolized primarily by CYP2C8, with minor contributions from CYP3A4.

Excretion: Excreted mainly in urine (via metabolites) and feces.

Half Life: 3-4 hours for unchanged drug, but effects last longer due to receptor binding.

Contraindications

  • Heart failure (NYHA Class III or IV)

Precautions

  • History of bladder cancer, liver disease, edema, or active hepatic disease; monitor liver function tests regularly. Use with caution in patients at risk for heart failure.

Adverse Reactions - Common

  • Weight gain (Common)
  • Edema (Common)
  • Upper respiratory tract infections (Common)

Adverse Reactions - Serious

  • Heart failure exacerbation (Uncommon but serious)
  • Hepatotoxicity (Rare)
  • Bone fractures (particularly in women) (Uncommon)
  • Myocardial infarction (controversial but noted in some studies) (Uncertain, but warrants caution)

Drug-Drug Interactions

  • Insulin - risk of edema and heart failure; hypoglycemia risk with insulin or other antidiabetics.
  • Ketoconazole - inhibits metabolism, increasing rosiglitazone levels.

Drug-Food Interactions

  • None specifically noted.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood glucose, HbA1c, liver function tests, and signs of heart failure. Regularly assess weight and edema.

Diagnoses:

  • Impaired skin integrity due to edema
  • Risk for hypoglycemia
  • Risk for heart failure

Implementation: Administer with or without food; educate patient on signs of edema, HF, and liver dysfunction.

Evaluation: Ensure blood glucose levels are within target range; monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of edema, weight gain, or shortness of breath.
  • Attend regular liver function testing.
  • Do not use alcohol excessively, as it may increase the risk of liver damage.

Special Considerations

Black Box Warnings:

  • Increased risk of myocardial infarction and heart failure. Use only if benefits outweigh risks.

Genetic Factors: N/A

Lab Test Interference: N/A

Overdose Management

Signs/Symptoms: Hypoglycemia, edema, signs of heart failure.

Treatment: Supportive care; no specific antidote. Discontinue medication, provide symptomatic treatment, and manage heart failure symptoms if present.

Storage and Handling

Storage: Store at controlled room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.