What’s Your Guidance for People Taking Avandia?

Some perspective on the diabetes drug, as the FDA prepares to consider its heart risks

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The Food and Drug Administration is scrutinizing the safety of diabetes drug Avandia, as concerns about its heart risks are swirling anew. What do you think?

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The controversy over Avandia was initiated by an article I wrote in May 2007 that appeared in the New England Journal of Medicine, suggesting that the drug increased the risk of heart attack.

The drug Avandia remains controversial. Many physicians have stopped prescribing Avandia, but others remain unconvinced about the risk. A recent study suggested that Avandia might be safe, but the study had many flaws and did not completely rule out the possibility that Avandia may increase the risk of heart attack. In July, the FDA will convene an advisory panel to consider what action to take, including the possibility of removing the drug from the market. Currently, American Diabetes Association guidelines do not recommend taking Avandia. Fortunately, there is a safe alternative, pioglitazone (Actos), which appears not to have the same heart attack risk as Avandia. Both Avandia and Actos carry warnings about fluid retention and heart failure, so don't use either drug if you carry the diagnosis of heart failure. Both drugs can also increase the risk of fracture, particularly in women.

Nissen's research on several diabetes drugs, including Actos, has been supported by the manufacturers. He has a long-standing policy of not accepting any fees from commercial entities.

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