Rosiglitazone Glibenclamide

Rosiglitazone 8 mg/day + glibenclamide 7.5 mg/day were compared with glibenclamide alone (maximum 15 mg/day) in 335 patients over 26 weeks (20). HbAlc fell by 0.81% with combination therapy. One patient taking combination therapy had a single episode of serious hypoglycemia mild... 

Kerenyi Z, Samer H, James R, Yan Y Stewart M. Combination therapy with rosiglitazone and glibenclamide compared with upward titration of glibenclamide alone in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2004 63 213-23. 

Yosefy C, Magen E, Kiselevich A, Priluk R, London D, Volchek L, Viskoper JR. Rosiglitazone improves, while glibenclamide worsens blood pressure control in treated hypertensive diabetic and dyslipidemic subjects via modulation of insulin resistance and sympathetic activity. J Cardiovasc Pharmacol 2004 44 215-22. 

In 203 patients, randomly assigned for 1 year to rosiglitazone 4 mg bd or glibenclamide to achieve optimal... 

Glibenclamide 2.5 mg/day + metformin 500 mg/day in a combination tablet was increased to a maximum of 10 mg/day + 2000 mg/day in patients with type 2 diabetes, mean age 57 years and weight 93 kg 181 patients also took rosiglitazone and 184 took placebo for 24 weeks... 

In 20 people with type 2 diabetes and hypertension taking glibenclamide 15 mg/day rosiglitazone 4 mg/day was added serum calcium and magnesium concentration rose slightly at 26 weeks (90). The significance of this is unknown. 

A 38-year-old woman was given insulin when glibenclamide and acarbose failed. Troglitazone 400 mg/day was added and increased to 800 mg/day 1 month later. After 2 months her liver function tests were normal, but she developed jaundice after 4 months. Total and direct bilirubin were 127 and 101 pmol/l and alanine transaminase was 34 pkat/l. After withdrawal of troglitazone her symptoms disappeared and her liver function tests normalized within several months. Metformin 1000 mg bd reduced her insulin requirement. Rosiglitazone 4 mg bd was added and her liver function tests remained normal for 10 months. 

In 203 patients, randomly assigned for 1 year to rosiglitazone 4 mg bd or glibenclamide to achieve optimal control, there was significant and sustained reduction in hyperglycemia and a significant reduction in diastolic blood pressure with rosiglitazone (26). There were no differences in adverse effects or in left ventricular mass index. 

If the patient with angina is diabetic, certain considerations apply. Insulin is eminently cardioprotective, as already described, while the sulfonylureas have an unfavorable profile. Probably less selective blockers as glimepiride should be preferred to glibenclamide.146 PPARy agonists such as rosiglitazone have been found to be cardioprotective262- 263 and to have an antiapoptotic effect in hypercholesterolemic rabbits subjected to myocardial ischemia/reperfusion.264... 

Table 2. Vascular serious adverse events during treatment with rosiglitazone, metformin or glibenclamide in the ADOPT-study population (for details see text and ref. 42).

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