I would like to commend Dagogo-Jack and Santiago1 on their excellent article. There are just 2 points that warrant further clarification.
First, since this article went to press, troglitazone has been indicated for use alone and with sulfonylureas.2 When used with sulfonylureas, troglitazone, 200 mg once daily, should be initiated. The current dose of sulfonylureas should be continued upon initiation of troglitazone therapy. For patients whose symptoms are not responding adequately, the troglitazone dose should be increased at 2 to 4 weeks. The maximum recommended dose of troglitazone is 600 mg once daily. The dose of sulfonylureas may require lowering to optimize therapy. Troglitazone can be used as monotherapy in patients whose symptoms are not adequately controlled with diet alone. The starting dose for this patient population is 400 or 600 mg once daily. For patients whose symptoms are not responding to 400 mg once daily, the dose of troglitazone should be increased to 600 mg after 6 to 8 weeks. For patients whose symptoms are not responding adequately to 600 mg of troglitazone after 6 to 8 weeks, alternative therapeutic options should be pursued.