Two diabetes drugs Avandia and Actos are in the news again. Both belong to a class of drugs called thiazolidinediones (TZD), which work by increasing insulin sensitivity. They can reduce blood sugar levels, but at a price. Both increase the risk of heart problems (heart attacks, heart failure, cardiac death), weight gain, and bone fractures.
The first suggestions that these drugs could be dangerous appeared in 2005, but were ignored. Then a 2007 study in New England Journal of Medicine (NEJM) showed a whopping 43% increase in heart attacks and up to 64% increased risk of death from cardiovascular causes in people using Avandia. This was harder to ignore, so the FDA (Food and Drug Administration) has convened a panel of experts who recommended adding a warning advising doctors about increased risk, but keeping the drug on the market.
Heart Health
In 1990 the FDA banned the sale of an amino acid called tryptophan, a natural substance present in most protein sources, such as turkey, milk, eggs, meat, and many others. The reason for the ban was that tryptophan was linked to a rare but serious condition called Eosinophilia Myalgia Syndrome (EMS). Eventually, it was determined that the cause of EMS was not tryptophan itself, but a contaminant found in one batch of the tryptophan capsules. All in all, there were a few thousand cases of EMS in the country, but FDA did not hesitate to take tryptophan off the market and the ban is still in effect today.
At its peak in 2006, 13.2 million people had taken Avandia. In 2008 (after the NEJM study) that number decreased to 4.6 million and even today an estimated 10,000 prescriptions are written every day. This translates into tens of thousands (maybe even hundreds of thousands) of deaths and heart attacks. But the FDA is not moving to remove Avandia from the market. Clearly, they are more concerned about drug company profits than about public safety. Plus, it shows a clear bias against the nutritional supplements.
The most recent study dealing with this subject came out in the British Medical Journal this month (August 2009). It compared the effects of Avandia and Actos in a group of almost 40,000 diabetic patients. Both drugs caused the same number of heart attacks. But there were more cases of heart failure and deaths in the group taking Avandia.
The researchers concluded that Actos was a better drug and that Avandia should not be used, since it offers no clear advantages over Actos. Many endocrinologists also seem to favor Actos instead of Avandia.
But the question is, should either one be used at all? Actos may cause fewer deaths, but it is still a very dangerous drug. It comes with a black box warning, so called because of the black border that surrounds the text of the warning. It is the strongest warning the FDA can require and is reserved for drugs that have a very high risk of serious and life-threatening side effects.
Just like Avandia, Actos increases the risk of heart failure, heart attack, cardiac death, edema due to water retention, and fractures. My opinion is that both drugs should be removed from the market. But the FDA did not ask me what I think, so doctors continue to prescribe both drugs and probably will continue to do so for the foreseeable future.
That is why I wanted you to know just how dangerous these drugs are. If you have diabetes and your doctor prescribed either Avandia or Actos, talk to him/her about Glucophage (Metformin), which also works by increasing insulin sensitivity. It is a lot less expensive and is not associated with increased risk of heart problems.
You can also improve your diet by eating foods that have low glycemic index, getting rid of any extra weight, and taking nutritional supplements.
For more information about good nutrition please click the link below.
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