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Drug - Thiazolidinedinones (TZDs)

December 2007

Therapeutic area - Diabetes

Preferred - No PA required Nonpreferred
15 mg, 30 mg, 45 mg
2 mg, 4 mg, 8 mg


  • Patient does not have heart failure
  • Patient does not have moderate to severe hepatic function impairment
  • The recipient has failed a trial of Actos, defined as a lack of efficacy or presence of significant side-effects
  • A patient must have had a 12 week trial of Actos before ineffectiveness can be documented

Increased weight gain or fluid retention is expected of either drug, but may constitute a definition of failure. It is possible that a patient will have different fluid-retention responses to the two TZDs. Patients with heart failure should not take either TZD or any combination with a TZD.

Authorization will not be granted if failure is defined as:

  • Ovulation that has resumed in premenopausal anovulatory patients

Neither of these drugs should be approved for use in patients who have:

  • Polycystic ovarian syndrome OR
  • Werner syndrome


See Grandfathering Criteria – which indicate patient specific criteria that would exclude a patient from switching to a preferred drug

Other notes

  • Actos is associated with mean decreases in triglycerides and increases in HDL
  • Avandia is associated with mean increases in total cholesterol, LDL, HDL
  • TZD use is not recommended in patients with moderate to severe hepatic function impairment
  • Avandia and Actos are contraindicated in NYHA class III and IV


MHCP Provider Call Center 651-431-2700 or 800-366-5411

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