Troglitazone Rezulin

a. This agent is associated with weight gain and hypoglycemia. Starting dose is 200 mg once per day, which may be slowly increased to up to 600 mg once per day. Troglitazone should be administered with a meal and is often taken with breakfast. Metformin is more potent and usually associated with less serious side effects; therefore, troglitazone is a second-line agent.

b. Idiosyncratic hepatocellular injury and liver failure associated with mortality has been reported. Liver function testing (AST, alkaline phosphatase, LDH, bilirubin) is recommended every 2 weeks for 6 months after starting the medication and periodically thereafter.

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