Rosiglitazone (trade name Avandia) is an antidiabetic drug in the thiazolidinedione class. It works as an insulin sensitizer, by binding to the PPAR in fat cells and making the cells more responsive to insulin. It is marketed by the pharmaceutical company GlaxoSmithKline (GSK) as a stand-alone drug or for use in combination with metformin or with glimepiride. First released in 1999, annual sales peaked at approximately $2.5-billion in 2006; however, following a meta-analysis in 2007 that linked the drugs use to an increased risk of heart attack, sales plummeted to just $9.5-million in 2012. The drugs patent expired in 2012.It was patented in 1987 and approved for medical use in 1999. Despite rosiglitazones effectiveness at decreasing blood sugar in type 2 diabetes mellitus, its use decreased dramatically as studies showed apparent associations with increased risks of heart attacks and death. Adverse effects alleged to be caused by rosiglitazone were the subject of over 13,000 lawsuits against GSK; as of July 2010, GSK had agreed to settlements on more than 11,500 of these suits. Some reviewers recommended rosiglitazone be taken off the market, but an FDA panel disagreed, and it remains available in the U.S. From November 2011 until November 2013, the federal government did not allow Avandia to be sold without a prescription from a certified doctor; moreover, patients were required to be informed of the risks associated with its use, and the drug had to be purchased by mail order through specified pharmacies.
Beta-blockers may slow the heart rate to a dangerous level if prescribed with calcium channel blocker-type medications. Bradycardia is also part of the mammalian diving reflex. Diagnosis
A diagnosis of bradycardia in adults is based on a heart rate less than 60 BPM, although some studies use a heart rate of less than 50 BPM. This is determined usually either by palpation or ECG. If symptoms occur, a determination of electrolytes may be helpful in determining the underlying cause. Management
The treatment of bradycardia is dependent on whether or not the person is stable or unstable. Stable
Emergency treatment is not needed if the person is asymptomatic or minimally symptomatic. Unstable
If a person is unstable, the initial recommended treatment is intravenous atropine. Doses less than 0.5 mg should not be used, as this may further decrease the rate. If this is not effective, intravenous inotrope infusion (dopamine, epinephrine) or transcutaneous pacing should be used. Transvenous pacing may be required if the cause of the bradycardia is not rapidly reversible.In children, giving oxygen, supporting their breathing, and chest compressions are recommended. Epidemiology
In clinical practice, elderly people over age 65 and young athletes of both sexes may have sinus bradycardia. The US Centers for Disease Control and Prevention reported in 2011 that 15.2% of adult males and 6.9% of adult females had clinically-defined bradycardia (a resting pulse rate below 60 BPM). Society and culture
Records
Daniel Green holds the world record for the slowest heartbeat in a healthy human, with a heart rate measured in 2014 of 26 BPM.