Several insulin products have updated labels warning that using them with a class of type 2 diabetes drugs known as TZDs (thiazolidinediones) increases the risk for heart failure. TZDs include Avandia (rosiglitazone) and Actos (pioglitazone).
The labels for Novolin N, Novolin 70/30, Humulin 70/30, Humulin N NPH, and Humulin R, include changes to the patient packet insert for patients to tell their health care provider of other medications they are taking, in particular if they are taking TZDs. “Taking … TZDs with this medicine may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs.”
Insulin products NovoLog, Levemir, NovoLog Mix 50/50, NovoLog Mix 70/30, Humalog, Humalog Mix 50/50, and Humalog Mix 70/30, also carry a warning that use with TZDs can cause dose-related fluid retention that may lead to or exacerbate heart failure.
Patients who take these drugs and continue treatment with TZDs are encouraged to tell their doctor if they have any new or worse symptoms of heart failure including shortness of breath, swelling of the ankles or feet, or sudden weight gain.
TZDs have had a checkered past. Rezulin (troglitazone), the first TZD introduced, was removed from the market because of an increased risk of drug-induced hepatitis. In 2010, the Food and Drug Administration (FDA) severely restricted the use of Avandia after it was linked to fatal heart attacks. A year later, the FDA warned that Actos was associated with an increased risk of bladder cancer.