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Rosiglitazone
Also known as: 122320-73-4, Avandia, Rosiglizole, 5-(4-(2-(methyl(pyridin-2-yl)amino)ethoxy)benzyl)thiazolidine-2,4-dione, Brl-49653, Brl 49653
Molecular Formula
C18H19N3O3S
Molecular Weight
357.4  g/mol
InChI Key
YASAKCUCGLMORW-UHFFFAOYSA-N
FDA UNII
05V02F2KDG

A thiazolidinedione that functions as a selective agonist for PPAR GAMMA. It improves INSULIN SENSITIVITY in adipose tissue, skeletal muscle, and the liver of patients with TYPE 2 DIABETES MELLITUS.
Rosiglitazone is a Peroxisome Proliferator Receptor gamma Agonist and Thiazolidinedione. The mechanism of action of rosiglitazone is as a Peroxisome Proliferator-activated Receptor Activity.
1 2D Structure

Rosiglitazone

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
5-[[4-[2-[methyl(pyridin-2-yl)amino]ethoxy]phenyl]methyl]-1,3-thiazolidine-2,4-dione
2.1.2 InChI
InChI=1S/C18H19N3O3S/c1-21(16-4-2-3-9-19-16)10-11-24-14-7-5-13(6-8-14)12-15-17(22)20-18(23)25-15/h2-9,15H,10-12H2,1H3,(H,20,22,23)
2.1.3 InChI Key
YASAKCUCGLMORW-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CN(CCOC1=CC=C(C=C1)CC2C(=O)NC(=O)S2)C3=CC=CC=N3
2.2 Other Identifiers
2.2.1 UNII
05V02F2KDG
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 5-((4-(2-methyl-2-(pyridinylamino)ethoxy)phenyl)methyl)-2,4-thiazolidinedione-2-butenedioate

2. Avandia

3. Brl 49653

4. Brl-49653

5. Brl49653

6. Rosiglitazone Maleate

2.3.2 Depositor-Supplied Synonyms

1. 122320-73-4

2. Avandia

3. Rosiglizole

4. 5-(4-(2-(methyl(pyridin-2-yl)amino)ethoxy)benzyl)thiazolidine-2,4-dione

5. Brl-49653

6. Brl 49653

7. Rezult

8. Brl49653

9. Rosiglitazone (avandia)

10. Avandaryl

11. Tdz 01

12. Gaudil

13. Rosvel

14. Avandamet

15. C18h19n3o3s

16. Chebi:50122

17. 5-[[4-[2-(methyl-2-pyridinylamino)ethoxy]phenyl]methyl]-2,4-thiazolidinedione

18. Mfcd00871760

19. Nsc-758698

20. Rosigilitazone

21. 2,4-thiazolidinedione, 5-((4-(2-(methyl-2-pyridinylamino)ethoxy)phenyl)methyl)-

22. 5-((4-(2-methyl-2-(pyridinylamino)ethoxy)phenyl)methyl)-2,4-thiazolidinedione-2-butenedioate

23. 05v02f2kdg

24. Tdz-01

25. Rosiglitazone (inn)

26. Ncgc00095124-01

27. Brl 49653c

28. 5-(4-{2-[methyl(pyridin-2-yl)amino]ethoxy}benzyl)-1,3-thiazolidine-2,4-dione

29. Rosiglitazone [inn]

30. 2,4-thiazolidinedione, 5-[[4-[2-(methyl-2-pyridinylamino)ethoxy]phenyl]methyl]-

31. 5-[[4-[2-[methyl(pyridin-2-yl)amino]ethoxy]phenyl]methyl]-1,3-thiazolidine-2,4-dione

32. Dsstox_cid_17131

33. Dsstox_rid_79303

34. Dsstox_gsid_37131

35. 5-[4-[2-[methyl(2-pyridyl)amino]ethoxy]benzyl]thiazolidine-2,4-dione

36. Rosiglitazone [inn:ban]

37. 5-[4-[2-(n-methyl-n-(2-pyridyl)amino)ethoxy]benzyl]thiazolidine-2,4-dione

38. 5-((4-(2-(methyl-2-pyridinylamino)ethoxy)phenyl)methyl)-2,4-thiazolidinedione

39. 5-[(4-{2-[methyl(pyridin-2-yl)amino]ethoxy}phenyl)methyl]-1,3-thiazolidine-2,4-dione

40. Cas-122320-73-4

41. Sr-01000763023

42. Rosiglitazona

43. Rosiglitazonum

44. Unii-05v02f2kdg

45. Rosi

46. Dtxsid7037131

47. Hsdb 7555

48. Rosiglitazone Base

49. 5-[4-[2-[n-methyl-n-(2-pyridyl)amino)ethoxy]benzyl]thiazolidine-2,4-dione

50. Rgz

51. Gaudil (tn)

52. Rosiglitazone- Bio-x

53. Spectrum_001703

54. 1217260-35-9

55. Spectrum2_001241

56. Spectrum3_000997

57. Spectrum4_001125

58. Spectrum5_001464

59. Rosiglitazone [mi]

60. Schembl5169

61. Dioxopromethazinehydrochloride

62. Rosiglitazone [hsdb]

63. Rosiglitazone [iarc]

64. Bspbio_002693

65. Kbiogr_001609

66. Kbioss_002183

67. Rosiglitazone [vandf]

68. Rosiglitazone [mart.]

69. Spectrum1504263

70. Spbio_001142

71. Rosiglitazone [who-dd]

72. Gtpl1056

73. Rosiglitazone [ema Epar]

74. Schembl14383595

75. Kbio2_002183

76. Kbio2_004751

77. Kbio2_007319

78. Kbio3_001913

79. Rosiglitazone, >=98% (hplc)

80. Hms1922j11

81. Hms2094o13

82. Hms3649g08

83. Hms3656k16

84. Hms3744m11

85. Hms3871l03

86. Hms3884n08

87. Pharmakon1600-01504263

88. Act04332

89. Bcp03047

90. Tox21_111434

91. Bdbm50030474

92. Ccg-39102

93. Nsc758698

94. Stl350047

95. Akos015894872

96. Tox21_111434_1

97. Ac-3459

98. Bcp9000017

99. Cs-1088

100. Db00412

101. Nsc 758698

102. Sb17326

103. Ncgc00095124-02

104. Ncgc00095124-03

105. Ncgc00095124-04

106. Ncgc00095124-05

107. Ncgc00095124-06

108. Ncgc00095124-08

109. Br164372

110. Hy-17386

111. Sy031184

112. Bcp0726000232

113. Ft-0602578

114. R0106

115. S2556

116. Sw197573-6

117. 20r734

118. 6p-065

119. D08491

120. S00306

121. Ab00698473-15

122. Ab00698473-17

123. Ab00698473-18

124. Ab00698473-19

125. Ab00698473_20

126. Ab00698473_21

127. Ab00698473_22

128. Ab00698473_23

129. Q424771

130. Q-201681

131. Sr-01000763023-5

132. Sr-01000763023-6

133. Brd-a97437073-001-02-3

134. Brd-a97437073-001-03-1

135. Brd-a97437073-001-04-9

136. Sr-01000763023-12

137. (rs)-5-{4-[2-(methyl-2-pyridylamino)ethoxy]benzyl}-2,4-thiazolidinedion

138. 5-(4-(2-(methyl(pyridin-2-yl)amino)ethoxy)-benzyl)thiazolidine-2,4-dione

139. 5-[4-[2-(n-methyl-n-(2-pyridyl)amino)ethoxy]benzyl]thiazolidine-2,4dione

140. Idmb (1um Brl49653, 1um Dexamethasone, 0.5um Ibmx, 10ug/ml Insulin)

141. (+/-)-5-[p-[2-(methyl-2-pyridylamino)ethoxy]benzyl]-2,4-thiazolidinedione

142. 2,4-thiazolidinedione, 5-[[4-[2-(methyl-2-pyridinylamino)ethoxy]phenyl]methyl]- (9ci)

143. 5-(4-(2-(n-methyl-n-(2-pyridinyl)amino)ethoxy)benzyl)-2,4-thiazolidinedione

144. 5-[[4-[2-(methyl-(2-pyridyl)amino)ethoxy]phenyl]methyl] Thiazolidine-2,4-dione

145. 5-[[4-[2-(methyl-2-pyridinylamino) Ethoxy]phenyl]methyl]-2,4-thiazolidinedione

146. 5-[[4-[2-(methyl-2-pyridinylamino)e Thoxy]phenyl]methyl]-2,4-thiazolidinedione

147. 5-[[4-[2-(methyl-pyridin-2-ylamino)ethoxy]phenyl]methyl]-1,3-thiazolidine-2,4-dione

148. 5-[4-[2-(n-methyl-n-(2-pyridyl)amino)ethoxy]benzyl] Thiazolidine-2,4-dione

149. 5-[4-[2-[n-methyl-n-(2-pyridyl)amino]ethoxy]phenyl Methyl]thiazolidine-2,4-dione

2.4 Create Date
2005-03-26
3 Chemical and Physical Properties
Molecular Weight 357.4 g/mol
Molecular Formula C18H19N3O3S
XLogP33.1
Hydrogen Bond Donor Count1
Hydrogen Bond Acceptor Count6
Rotatable Bond Count7
Exact Mass357.11471265 g/mol
Monoisotopic Mass357.11471265 g/mol
Topological Polar Surface Area96.8 Ų
Heavy Atom Count25
Formal Charge0
Complexity469
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count1
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 6  
Drug NameAvandaryl
PubMed HealthRosiglitazone/Glimepiride (By mouth)
Drug ClassesAntidiabetic
Active Ingredientrosiglitazone maleate; Glimepiride
Dosage FormTablet
RouteOral
Strength4mg; 2mg; 1mg; 8mg
Market StatusPrescription
CompanySb Pharmco

2 of 6  
Drug NameAvandia
PubMed HealthRosiglitazone (By mouth)
Drug ClassesAntidiabetic
Drug LabelAVANDIA (rosiglitazone maleate) is an oral antidiabetic agent which acts primarily by increasing insulin sensitivity. AVANDIA improves glycemic control while reducing circulating insulin levels. Rosiglitazone maleate is not chemically or functionally...
Active IngredientRosiglitazone maleate
Dosage FormTablet
RouteOral
Strengtheq 4mg base; eq 2mg base; eq 8mg base
Market StatusPrescription
CompanySb Pharmco

3 of 6  
Drug NameRosiglitazone
PubMed HealthRosiglitazone (By mouth)
Drug ClassesAntidiabetic
Drug LabelAVANDIA (rosiglitazone maleate) is an oral antidiabetic agent which acts primarily by increasing insulin sensitivity. AVANDIA improves glycemic control while reducing circulating insulin levels. Rosiglitazone maleate is not chemically or functionally...
Active IngredientRosiglitazone maleate
Dosage FormTablet
Routeoral
Strength8mg; 4mg; 2mg
Market StatusTentative Approval
CompanyWatson Labs; Dr Reddys Labs

4 of 6  
Drug NameAvandaryl
PubMed HealthRosiglitazone/Glimepiride (By mouth)
Drug ClassesAntidiabetic
Active Ingredientrosiglitazone maleate; Glimepiride
Dosage FormTablet
RouteOral
Strength4mg; 2mg; 1mg; 8mg
Market StatusPrescription
CompanySb Pharmco

5 of 6  
Drug NameAvandia
PubMed HealthRosiglitazone (By mouth)
Drug ClassesAntidiabetic
Drug LabelAVANDIA (rosiglitazone maleate) is an oral antidiabetic agent which acts primarily by increasing insulin sensitivity. AVANDIA improves glycemic control while reducing circulating insulin levels. Rosiglitazone maleate is not chemically or functionally...
Active IngredientRosiglitazone maleate
Dosage FormTablet
RouteOral
Strengtheq 4mg base; eq 2mg base; eq 8mg base
Market StatusPrescription
CompanySb Pharmco

6 of 6  
Drug NameRosiglitazone
PubMed HealthRosiglitazone (By mouth)
Drug ClassesAntidiabetic
Drug LabelAVANDIA (rosiglitazone maleate) is an oral antidiabetic agent which acts primarily by increasing insulin sensitivity. AVANDIA improves glycemic control while reducing circulating insulin levels. Rosiglitazone maleate is not chemically or functionally...
Active IngredientRosiglitazone maleate
Dosage FormTablet
Routeoral
Strength8mg; 4mg; 2mg
Market StatusTentative Approval
CompanyWatson Labs; Dr Reddys Labs

4.2 Therapeutic Uses

Antidiabetic agent

National Library of Medicine's Medical Subject Headings. Rosiglitazone. Online file (MeSH, 2018). Available from, as of January 22, 2018: https://meshb.nlm.nih.gov/search


/CLINICAL TRIALS/ ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. The Web site is maintained by the National Library of Medicine (NLM) and the National Institutes of Health (NIH). Each ClinicalTrials.gov record presents summary information about a study protocol and includes the following: Disease or condition; Intervention (for example, the medical product, behavior, or procedure being studied); Title, description, and design of the study; Requirements for participation (eligibility criteria); Locations where the study is being conducted; Contact information for the study locations; and Links to relevant information on other health Web sites, such as NLM's MedlinePlus for patient health information and PubMed for citations and abstracts for scholarly articles in the field of medicine. Rosiglitazone is included in the database.

NIH/NLM; ClinicalTrials.Gov. Available from, as of January 22, 2018: https://clinicaltrials.gov/


Rosiglitazone is used as monotherapy or in combination with a sulfonylurea, metformin hydrochloride, or a sulfonylurea and metformin as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus. Rosiglitazone in fixed combination with metformin hydrochloride is used as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus. Rosiglitazone also is used in fixed combination with glimepiride as an adjunct to diet and exercise for the management of type 2 diabetes mellitus. /Included in US product label/

American Society of Health-System Pharmacists 2017; Drug Information 2017. Bethesda, MD. 2017, p. 3301


/EXPL THER/ 1-Methyl-4-phenylpyridinium ion (MPP(+)), an inhibitor of mitochondrial complex I, has been widely used as a neurotoxin because it elicits a severe Parkinson's disease-like syndrome with elevation of intracellular reactive oxygen species (ROS) level and apoptotic death. Rosiglitazone, a peroxisome proliferator-activated receptor (PPAR)-gamma agonist, has been known to show various non-hypoglycemic effects, including anti-inflammatory, anti-atherogenic, and anti-apoptotic. In the present study, /the authors/ investigated the protective effects of rosiglitazone on MPP(+) induced cytotoxicity in human neuroblastoma SH-SY5Y cells, as well as underlying mechanism. /Their/ results suggested that the protective effects of rosiglitazone on MPP(+) induced apoptosis may be ascribed to its anti-oxidative properties, anti-apoptotic activity via inducing expression of SOD and catalase and regulating the expression of Bcl-2 and Bax. These data indicated that rosiglitazone might provide a valuable therapeutic strategy for the treatment of progressive neurodegenerative disease such as Parkinson's disease.

PMID:17266988 Jung T, Lee J et al; J Neurol Sci 253 (1-2): 53-60 (2007)


4.3 Drug Warning

/BOXED WARNING/ WARNING: CONGESTIVE HEART FAILURE. Thiazolidinediones, including rosiglitazone, cause or exacerbate congestive heart failure in some patients. After initiation of Avandia, and after dose increases, observe patients carefully for signs and symptoms of heart failure (including excessive, rapid weight gain; dyspnea; and/or edema). If these signs and symptoms develop, the heart failure should be managed according to current standards of care. Furthermore, discontinuation or dose reduction of Avandia must be considered. Avandia is not recommended in patients with symptomatic heart failure. Initiation of Avandia in patients with established NYHA Class III or IV heart failure is contraindicated.

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


Thiazolidinediones, including rosiglitazone, alone or in combination with other antidiabetic agents, can cause fluid retention and may lead to or exacerbate congestive heart failure (CHF). Use of thiazolidinediones is associated with an approximately twofold increased risk of CHF. Patients should be observed for signs and symptoms of CHF (e.g., dyspnea, rapid weight gain, edema, unexplained cough or fatigue), especially during initiation of therapy and dosage titration. If signs and symptoms of CHF develop, the disorder should be managed according to current standards of care. In addition, a decrease in the dosage of rosiglitazone or discontinuance of the drug should be considered.

American Society of Health-System Pharmacists 2017; Drug Information 2017. Bethesda, MD. 2017, p. 3303


Thiazolidinedione use is associated with bone loss and fractures in women and possibly in men with type 2 diabetes mellitus. In long-term comparative clinical trials in patients with type 2 diabetes mellitus, the incidence of bone fracture was increased in patients (particularly women) receiving rosiglitazone versus comparator agents (glyburide and/or metformin). Such effects were noted after the first year of treatment and persisted throughout the study. The majority of fractures observed in patients taking thiazolidinediones were in a distal upper limb (i.e., forearm, hand, wrist) or distal lower limb (i.e., foot, ankle, fibula, tibia). In an observational study in the United Kingdom in men and women (mean age: 60.7 years) with diabetes mellitus, use of pioglitazone or rosiglitazone for approximately 12-18 months (as estimated from prescription records) was associated with a twofold to threefold increase in fractures, particularly of the hip and wrist. The overall risk of fracture was similar among men and women and was independent of body mass index, comorbid conditions, diabetic complications, duration of diabetes mellitus, and use of other oral antidiabetic drugs.145 Risk of fractures should be considered when initiating or continuing thiazolidinedione therapy in female patients with type 2 diabetes mellitus. Bone health should be assessed and maintained according to current standards of care. Although increased risk of fracture may also apply to men, the risk appears to be higher among women than men.

American Society of Health-System Pharmacists 2017; Drug Information 2017. Bethesda, MD. 2017, p. 3304


Because rosiglitazone requires endogenous insulin for activity, it should not be used in patients with type 1 diabetes mellitus or diabetic ketoacidosis.

American Society of Health-System Pharmacists 2017; Drug Information 2017. Bethesda, MD. 2017, p. 3302


For more Drug Warnings (Complete) data for Rosiglitazone (19 total), please visit the HSDB record page.


4.4 Drug Indication

Rosiglitazone is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.


FDA Label


AVANDAMET is indicated in the treatment of type 2 diabetes mellitus patients, particularly overweight patients:

- who are unable to achieve sufficient glycaemic control at their maximally tolerated dose of oral metformin alone.

- in triple oral therapy with sulphonylurea in patients with insufficient glycaemic control despite dual oral therapy with their maximally tolerated dose of metformin and a sulphonylurea (see section 4. 4).


Rosiglitazone is indicated in the treatment of type 2 diabetes mellitus:

as monotherapy

-in patients (particularly overweight patients) inadequately controlled by diet and exercise for whom metformin is inappropriate because of contraindications or intolerance

as dual oral therapy in combination with

-metformin, in patients (particularly overweight patients) with insufficient glycaemic control despite maximal tolerated dose of monotherapy with metformin

-a sulphonylurea, only in patients who show intolerance to metformin or for whom metformin is contraindicated, with insufficient glycaemic control despite monotherapy with a sulphonylurea

as triple oral therapy in combination with

-metformin and a sulphonylurea, in patients (particularly overweight patients) with insufficient glycaemic control despite dual oral therapy (see section 4. 4).


Rosiglitazone is indicated as oral monotherapy in type 2 diabetes mellitus patients, particularly overweight patients, inadequately controlled by diet and exercise for whom metformin is inappropriate because of contraindications or intolerance.

Rosiglitazone is also indicated for oral combination treatment in type 2 diabetes mellitus patients with insufficient glycaemic control despite maximal tolerated dose of oral monotherapy with either metformin or a sulphonylurea:

- in combination with metformin particularly in overweight patients.

- in combination with a sulphonylurea only in patients who show intolerance to metformin or for whom metformin is contraindicated.


Rosiglitazone is indicated as oral monotherapy in type 2 diabetes mellitus patients, particularly overweight patients, inadequately controlled by diet and exercise for whom metformin is inappropriate because of contraindications or intolerance.

Rosiglitazone is also indicated for oral combination treatment in type 2 diabetes mellitus patients with insufficient glycaemic control despite maximal tolerated dose of oral monotherapy with either metformin or a sulphonylurea:

- in combination with metformin particularly in overweight patients.

- in combination with a sulphonylurea only in patients who show intolerance to metformin or for whom metformin is contraindicated.


5 Pharmacology and Biochemistry
5.1 Pharmacology

When rosiglitazone is used as monotherapy, it is associated with increases in total cholesterol, LDL, and HDL. It is also associated with decreases in free fatty acids. Increases in LDL occurred primarily during the first 1 to 2 months of therapy with AVANDIA and LDL levels remained elevated above baseline throughout the trials. In contrast, HDL continued to rise over time. As a result, the LDL/HDL ratio peaked after 2 months of therapy and then appeared to decrease over time.


5.2 MeSH Pharmacological Classification

Hypoglycemic Agents

Substances which lower blood glucose levels. (See all compounds classified as Hypoglycemic Agents.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
ROSIGLITAZONE
5.3.2 FDA UNII
05V02F2KDG
5.3.3 Pharmacological Classes
Chemical Structure [CS] - Thiazolidinediones
5.4 ATC Code

A10BD03


A10BG02


A10BG02


A10BG02


A - Alimentary tract and metabolism

A10 - Drugs used in diabetes

A10B - Blood glucose lowering drugs, excl. insulins

A10BG - Thiazolidinediones

A10BG02 - Rosiglitazone


5.5 Absorption, Distribution and Excretion

Absorption

The absolute bioavailability of rosiglitazone is 99%. Peak plasma concentrations are observed about 1 hour after dosing. Administration of rosiglitazone with food resulted in no change in overall exposure (AUC), but there was an approximately 28% decrease in Cmax and a delay in Tmax (1.75 hours). These changes are not likely to be clinically significant; therefore, rosiglitazone may be administered with or without food. Maximum plasma concentration (Cmax) and the area under the curve (AUC) of rosiglitazone increase in a dose-proportional manner over the therapeutic dose range.


Route of Elimination

Following oral or intravenous administration of [14C]rosiglitazone maleate, approximately 64% and 23% of the dose was eliminated in the urine and in the feces, respectively.


Volume of Distribution

17.6 L [oral volume of distribution Vss/F]

13.5 L [population mean, pediatric patients]


Clearance

Oral clearance (CL) = 3.03 0.87 L/hr [1 mg Fasting]

Oral CL = 2.89 0.71 L/hr [2 mg Fasting]

Oral CL = 2.85 0.69 L/hr [8 mg Fasting]

Oral CL = 2.97 0.81 L/hr [8 mg Fed]

3.15 L/hr [Population mean, Pediatric patients]


In a study in healthy volunteers, the absorption of rosiglitazone was relatively rapid, with 99% oral bioavailability after oral absorption.

IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work). Available at: https://monographs.iarc.fr/ENG/Classification/index.php, p. V108 362 (2016)


Severe forms of non-alcoholic fatty liver disease (NAFLD) adversely affect the liver physiology and hence the pharmacokinetics of drugs. Here, we investigated the effect of NAFLD on the pharmacokinetics of rosiglitazone, an insulin sensitizer used in the treatment of type 2 diabetes. Male C57BL/6 mice were divided into two groups. The first group (n=14) was fed with normal chow feed and the second group (n=14) was fed with 60% high-fat diet (HFD) and 40% high fructose liquid (HFL) for 60 days to induce NAFLD. The development of NAFLD was confirmed by histopathology, liver triglyceride levels and biochemical estimations, and used for pharmacokinetic investigations. Rosiglitazone was administered orally at 30 mg/kg dose. At predetermined time points, blood was collected and rosiglitazone concentrations were determined using LC/MS/MS. Plasma concentrations were subjected to non-compartmental analysis using Phoenix WinNonlin (6.3), and the area under the plasma concentration-time curve (AUC) was calculated by the linear-up log-down method. HFD and HFL diet successfully induced NAFLD in mice. Rosiglitazone pharmacokinetics in NAFLD animals were altered significantly as compared to healthy mice. Rosiglitazone exposure increased significantly in NAFLD mice (2.5-fold higher AUC than healthy mice). The rosiglitazone oral clearance was significantly lower and the mean plasma half-life was significantly longer in NAFLD mice as compared to healthy mice. The NAFLD mouse model showed profound effects on rosiglitazone pharmacokinetics. The magnitude of change in rosiglitazone pharmacokinetics is similar to that observed in humans with moderate to severe liver disease. The present animal model can be utilized to study the NAFLD-induced changes in the pharmacokinetics of different drugs.

PMID:27522101 Kulkarni NM et al; Drug Metab Pers Ther 31 (3): 165-71 (2016)


The absolute bioavailability of rosiglitazone is 99%. Peak plasma concentrations are observed about 1 hour after dosing. Administration of rosiglitazone with food resulted in no change in overall exposure (AUC), but there was an approximately 28% decrease in Cmax and a delay in Tmax (1.75 hours). These changes are not likely to be clinically significant; therefore, Avandia may be administered with or without food.

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


The mean (CV%) oral volume of distribution (Vss/F) of rosiglitazone is approximately 17.6 (30%) liters, based on a population pharmacokinetic analysis. Rosiglitazone is approximately 99.8% bound to plasma proteins, primarily albumin.

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


For more Absorption, Distribution and Excretion (Complete) data for Rosiglitazone (8 total), please visit the HSDB record page.


5.6 Metabolism/Metabolites

Hepatic. Rosiglitazone is extensively metabolized in the liver to inactive metabolites via N-demethylation, hydroxylation, and conjugation with sulfate and glucuronic acid. In vitro data have shown that Cytochrome (CYP) P450 isoenzyme 2C8 (CYP2C8) and to a minor extent CYP2C9 are involved in the hepatic metabolism of rosiglitazone.


The main metabolites observed in humans are also observed in rats; however, the clearance in rats was almost ten times higher than in humans, probably due to the higher levels of CYP2C in rat microsomes.

IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work). Available at: https://monographs.iarc.fr/ENG/Classification/index.php, p. V108 364 (2016)


In vitro data demonstrate that rosiglitazone is predominantly metabolized by Cytochrome P450 (CYP) isoenzyme 2C8, with CYP2C9 contributing as a minor pathway.

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


Rosiglitazone is extensively metabolized with no unchanged drug excreted in the urine. The major routes of metabolism were N-demethylation and hydroxylation, followed by conjugation with sulfate and glucuronic acid. All the circulating metabolites are considerably less potent than parent and, therefore, are not expected to contribute to the insulin-sensitizing activity of rosiglitazone.

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


Rosiglitazone has known human metabolites that include N-Desmethylrosiglitazone, ortho-hydroxyrosiglitazone, and para-hydroxyrosiglitazone.

S73 | METXBIODB | Metabolite Reaction Database from BioTransformer | DOI:10.5281/zenodo.4056560


5.7 Biological Half-Life

3-4 hours (single oral dose, independent of dose)


The elimination half-life of rosiglitazone was 3-4 hours and was independent of dose. The time to Cmax and the elimination half-life for two metabolites in plasma were significantly longer than for rosiglitazone itself (4-6 hours versus 0.5-1 hours, and about 5 days versus 3-7 hours).

IARC. Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Humans. Geneva: World Health Organization, International Agency for Research on Cancer, 1972-PRESENT. (Multivolume work). Available at: https://monographs.iarc.fr/ENG/Classification/index.php, p. V108 362 (2016)


The plasma half life of (14)C-related material ranged from 103 to 158 hours.

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


5.8 Mechanism of Action

Rosiglitazone acts as a highly selective and potent agonist at peroxisome proliferator activated receptors (PPAR) in target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPAR-gamma receptors regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In this way, rosiglitazone enhances tissue sensitivity to insulin.


Because osteoblasts and marrow adipocytes are derived from a common mesenchymal progenitor, increased adipogenesis may occur at the expense of osteoblasts, leading to bone loss. Our previous in vitro studies indicated that activation of the proadipogenic transcription factor peroxisome proliferator-activated receptor isoform gamma 2 with rosiglitazone suppressed osteoblast differentiation. Here, we show that 5-month-old Swiss-Webster mice receiving rosiglitazone for 28 day exhibited bone loss associated with an increase in marrow adipocytes, a decrease in the ratio of osteoblasts to osteoclasts, a reduction in bone formation rate, and a reduction in wall width--an index of the amount of bone formed by each team of osteoblasts. Rosiglitazone had no effect on the number of early osteoblast or osteoclast progenitors, or on osteoblast life span, but decreased the expression of the key osteoblastogenic transcription factors Runx2 and Osterix in cultures of marrow-derived mesenchymal progenitors. These effects were associated with diversion of bipotential progenitors from the osteoblast to the adipocyte lineage, and suppression of the differentiation of monopotential osteoblast progenitors. However, rosiglitazone had no effect on osteoblastic cells at later stages of differentiation. Hence, rosiglitazone attenuates osteoblast differentiation and thereby reduces bone formation rate in vivo, leading to bone loss. These findings provide a mechanistic explanation for the recent evidence that peroxisome proliferator-activated receptor isoform gamma activation is a negative regulator of bone mass and suggest that the increased production of oxidized fatty acids with age may indeed be an important mechanism for age-related osteoporosis in humans.

PMID:15591153 Ali AA et al; Endocrinology 146 (3): 1226-35 (2005)


Brain peroxisome proliferator-activated receptor gamma (PPARgamma), a member of the nuclear receptor superfamily of ligand-dependent transcription factors, is involved in neuroprotection. It is activated by the drug rosiglitazone, which then can increase the pro-survival protein B-cell lymphoma 2 (BCL-2), to mediate neuroprotection. However, the mechanism underlying this molecular cascade remains unknown. Here, we show that the neuroprotective protein neurotrophic factor-a1 (NF-a1), which also induces the expression of BCL-2, has a promoter that contains PPARgamma-binding sites that are activated by rosiglitazone. Treatment of Neuro2a cells and primary hippocampal neurons with rosiglitazone increased endogenous NF-a1 expression and prevented H2 O2 -induced cytotoxicity. Concomitant with the increase in NF-a1, BCL-2 was also increased in these cells. When siRNA against NF-a1 was used, the induction of BCL-2 by rosiglitazone was prevented, and the neuroprotective effect of rosiglitazone was reduced. These results demonstrate that rosiglitazone-activated PPARgamma directly induces the transcription of NF-a1, contributing to neuroprotection in neurons. We proposed the following cascade for neuroprotection against oxidative stress by rosiglitazone: Rosiglitazone enters the neuron and binds to peroxisome proliferator-activated receptor gamma (PPARgamma) in the nucleus. The PPARgamma-rosiglitazone complex binds to the neurotrophic factor-a1 (NF-a1) promoter and activates the transcription of NF-a1 mRNA which is then translated to the protein. NF-a1 is the secreted, binds to a cognate receptor and activates the extracellular signal-regulated kinases (ERK) pathway. This in turn enhances the expression of the pro-survival protein, B-cell lymphoma 2 (BCL-2) and inhibition of caspase 3 (Csp-3) to mediate neuroprotection under oxidative stress. Akt, protein kinase B (PKB).

PMID:25940785 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496294 Thouennon E et al; J Neurochem 134 (3): 463-70 (2015)


Rosiglitazone, a member of the thiazolidinedione class of antidiabetic agents, improves glycemic control by improving insulin sensitivity. Rosiglitazone is a highly selective and potent agonist for the peroxisome proliferator-activated receptor-gamma (PPARgamma). In humans, PPAR receptors are found in key target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPARgamma nuclear receptors regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In addition, PPARgamma- responsive genes also participate in the regulation of fatty acid metabolism

GlaxoSmithKline (GSK); Prescribing Information for Avandia (Rosiglitazone Maleate) Tablets, (Revised September 2016). Available from, as of January 30, 2018: https://www.gsksource.com/pharma/content/gsk/source/us/en/brands.html?type=Prescription


Rosiglitazone acts principally by increasing insulin sensitivity in target tissues, as well as decreasing hepatic gluconeogenesis. Rosiglitazone is a peroxisome proliferator-activated receptorgamma (PPARgamma) agonist that increases transcription of insulin-responsive genes and increases insulin sensitivity. Rosiglitazone, like other thiazolidinediones, ameliorates insulin resistance associated with type diabetes mellitus without stimulating insulin release from pancreatic beta cells, thus avoiding the risk of hypoglycemia. Because rosiglitazone does not lower glucose concentrations below euglycemia, the drug is appropriately referred to as an antidiabetic agent rather than a hypoglycemic agent. Some evidence suggests that the glucoregulatory effects of thiazolidinediones are mediated in part via reduced systemic and tissue lipid availability. Circulating concentrations of insulin and C-peptide are reduced during rosiglitazone therapy.

American Society of Health-System Pharmacists 2017; Drug Information 2017. Bethesda, MD. 2017, p. 3305


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