Home Drug Guide Troglitazone

Drug Guide

Generic Name

Troglitazone

Brand Names Prelay, Rezulin

Classification

Therapeutic: Antidiabetic agent

Pharmacological: Thiazolidinedione (TZD) class, insulin sensitizer

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

Assessment: Monitor liver function tests (LFTs) regularly; assess for signs of hepatic toxicity.

Diagnoses:

  • Risk for liver injury
  • Imbalanced nutrition: less than body requirements due to GI side effects

Implementation: Administer with meals to reduce gastrointestinal upset; educate patient on signs of liver dysfunction.

Evaluation: Regularly evaluate liver function tests and monitor for adverse reactions.

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.

🛡️ 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.