DTB reviews glitazones

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The Pharmaceutical Journal
Vol 280 No 7498 p460
19 April 2008

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DTB reviews glitazones

There is no convincing evidence that glitazones offer clinical benefit over metformin or sulphonylureas when used as monotherapy in type 2 diabetes, the Drug and Therapeutics Bulletin has concluded (2008;46:25).

Glitazones should be reserved, the DTB says, for use in combination with a sulphonylurea for patients unsuitable for treatment with metformin or in combination with metformin for patients unsuitable for treatment with a sulphonylurea.

Its use in addition to both metformin and a sulphonylurea should be restricted to patients unsuitable for treatment with insulin, the DTB says.

Antidepressants and heart disease Selective serotonin reuptake inhibitors are likely to be the best first-line treatment for depression in patients with heart disease, another DTB review concludes (ibid, p29).

It says that, although there is little evidence from clinical trials to guide antidepressant choice for patients with heart disease, tricyclic antidepressants are best avoided (because they can cause arrhythmias), but SSRIs appear to be relatively free of unwanted cardiac effects.