Troglitazone has been reported to cause liver-related deaths and transplants, whereas hepatotoxicity has not yet been reported with the two newer agents. However, there has been one report of hepatotoxicity in a patient treated with rosiglitazone since the product went to market. The recommended frequency of liver function monitoring is less for initial therapy with rosiglitazone and pioglitazone as compared to troglitazone. In studies, pioglitazone has been reported to decrease triglyceride levels and increase HDL levels, whereas troglitazone and rosiglitazone have been reported to increase LDL levels. However, the clinical significance is unknown.
All agents have comparable acquisition costs.
Troglitazone remain on the formulary with the same restrictive criteria. Rosiglitazone and pioglitazone retain their nonformulary status. These agents may be used if patients are admitted on either one. An endocrinology consult and nonformulary request would need to be obtained for inpatients being initiated on either rosiglitazone or pioglitazone. It was recommended that a utilization review be conducted in the near future for these agents because of the lack of data.