Thiazolidinediones are agents used to improve insulin sensitivity in type 2 diabetes. We are currently conducting an institutional review board-approved research study to examine the effects of pioglitazone on metabolic parameters in upper body-obese volunteers. One of the volunteers developed a sore throat 7 days after starting the pioglitazone (30 mg, once daily), followed by dyspnea and swelling of the lips and tongue. On physical examination, swollen lips and tenderness of the pharynx were noted and slight wheezing was heard. No rash was seen. Laboratory values, including leukocytes and eosinophils, were normal. This condition was diagnosed as an angioneurotic edema, and the symptoms rapidly diminished after administration of intravenous steroids.
The volunteer had been using Orthotricycline for several years, which was continued after this event without problems. She had not eaten allergenic foods (such as strawberries or shrimp) or anything out of the ordinary. She had multiple allergies, including to radiographic contrast dye, codeine, Ultram, and Midrin. She had not previously experienced angioneurotic edema.
After discontinuation of pioglitazone, the symptoms did not recur. We concluded that the angioneurotic edema was caused by pioglitazone, even though, to our knowledge, this has not been reported as a side effect before.
This finding, however, is of particular importance, considering the frequent use of thiazolidinediones as comedication with ACE inhibitors and other drugs known to cause angioneurotic edema. In case this condition occurs, thiazolidinediones, pioglitazone in particular, should also be considered as the possible trigger.
Address correspondence to S. Shadid, MD, Endocrine Research Unit, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. E-mail: [email protected].
S.S. and M.D.J. have received research support from Takeda to investigate the effects of pioglitazone on intramuscular triglyceride metabolism.
