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Pharmacokinetic Interactions with Thiazolidinediones

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Abstract

Type 2 diabetes mellitus is a complex disease combining defects in insulin secretion and insulin action. New compounds called thiazolidinediones or glitazones have been developed for reducing insulin resistance. After the withdrawal of troglitazone because of liver toxicity, two compounds are currently used in clinical practice, rosiglitazone and pioglitazone. These compounds are generally used in combination with other pharmacological agents. Because they are metabolised via cytochrome P450 (CYP), glitazones are exposed to numerous pharmacokinetic interactions. CYP2C8 and CYP3A4 are the main isoenzymes catalysing biotransformation of pioglitazone (as with troglitazone), whereas rosiglitazone is metabolised by CYP2C9 and CYP2C8. For both rosiglitazone and pioglitazone, the most relevant interactions have been described in healthy volunteers with rifampicin (rifampin), which results in a significant decrease of area under the plasma concentration-time curve [AUC] (54–65% for rosiglitazone, p < 0.001; 54% for pioglitazone, p < 0.001), and with gemfibrozil, which results in a significant increase of AUC (130% for rosiglitazone, p < 0.001; 220–240% for pioglitazone, p < 0.001). The relevance of such drug-drug interactions in patients with type 2 diabetes remains to be evaluated. However, in the absence of clinical data, it is prudent to reduce the dosage of each glitazone by half in patients treated with gemfibrozil. Conversely, rosiglitazone and pioglitazone do not seem to significantly affect the pharmacokinetics of other compounds. Although some food components have also been shown to potentially interfere with drugs metabolised with the CYP system, no published study deals specifically with these possible CYP-mediated food-drug interactions with glitazones.

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No sources of funding were used to assist in the preparation of this review. Authors have no conflicts of interest that are directly relevant to the content of this reveiw.

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  1. Division of Diabetes, Nutrition and Metabolic Disorders and Division of Clinical Pharmacology, Department of Medicine, CHU Sart Tilman, University of Liège, Liège, Belgium

    André J. Scheen

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Scheen, A.J. Pharmacokinetic Interactions with Thiazolidinediones. Clin Pharmacokinet 46, 1–12 (2007). https://doi.org/10.2165/00003088-200746010-00001

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