[pharout]

I would say, first and foremost (assuming normal hepatic function), monitor fluid retention and wt gain in light of the SCr elevation. This can be a particular problem in pts with certain cardiac problems (I'm also assuming the pt does not have class III or IV CHF), such as left ventricular dysfunction. In fact, renal dysfunction would require precautionary use of Actos according to our endocrinology dept. Second, monitor liver function tests (mainly ALT) on a quarterly basis at minimum.