Actos

[jeffradd]

what do you feel needs to be monitored the most to the least with a newly diagnosed diabetic patient taking Actos with chronic renal insufficiency with SrCr of 1.8 mg/dL

Blood glucose (hypoglycemia)

Edema

Liver function

[johnep]

Ah now you have got me. I await answers with interest.
Today have my first MUR.
johnep

[Steve G]

Do LFTs before treatment and periodically (rare reports of liver problems). Glitazones reduce peripheral insulin resistance, so are less likely than sulphonylureas to cause hypoglycaemia, but would probably keep an eye on blood glucose levels to start with.

You might want to check your SrCr value: 1.8mg/dL = 18mg/l (>700 mcg/l is classed as severe in BNF).

[jeffradd]

so with regards to toxicity of actos with this patient we would watch these three in this order?

liver function
hypoglycemia
edema

[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.