The manufacturers of thiazolidinedione drugs have warnings on the risk of heart failure with these drugs, the use for the treatment of type 2 diabetes should be strengthened. They are like Avandia (rosiglitazone maleate), Avandaryl (rosiglitazone maleate and glimepiride) and Avandamet (rosiglitazone maleate and metformin hydrochloride) containing all the rosiglitazone and Actos (pioglitazone hydrochloride), Duetact (pioglitazone hydrochloride and Glimepride) and actoplus sold met all contain pioglitazone. The drug labels already include information about the risk of heart failure, but now there is a new boxed warning highlighting again that these drugs cause or worsen heart failure in some patients, and stresses the importance of carefully tracking patients for signs of heart failure. The labeling recommends that after initiation of thiazolidinedione therapy or increasing the dose, patients should be closely monitored for signs and symptoms of heart failure, including excessive, rapid weight gain, shortness of breath and edema. If any of these signs and symptoms develop and heart failure is confirmed, practitioners should begin to consider appropriate management of heart failure and stop or reduce the dose. The box warning also states that these drugs are not recommended in patients with symptomatic heart failure and cons are not appropriate, especially in patients with NYHA class III or IV heart failure.