Singapore is the latest country to restrict the use of GlaxoSmithKline's anti-diabetes drug Avandia, following the EU's suspension of the marketing of the drug. The FDA in the US has also decided that Avandia will have to have additional safety labelling but it can continue to be prescribed to new patients if other treatments do not work. Avandia used to be the biggest selling anti-diabetes drug but GSK admits sales are likely to be low after the latest regulatory announcements. Many doctors have already been prescribing alternative treatments. Avandia sales fell by 18% to £321m in the first half of 2010, with the decline accelerating in the second quarter, and they will fall sharply again in the second half. Next year sales will be minimal. The Health Sciences Authority in Singapore says that it will "significantly limit" Avandia's use. The advice should ensure the drug is only prescribed to "a small group of patients who do not have certain heart or other conditions that may render them more susceptible to the potential adverse effects". There have been reports that Avandia can cause heart failure or strokes in diabetics. That is why the European Medicines Agency recommended the suspension of sales of the drug in the EU. The European Commission is expected to confirm the suspension in a couple of weeks. Confirmation of the suspension of the marketing of Avandia in the EU came just after the market closed on Thursday but GSK was already lower ahead of the announcement. The shares have fallen further today. The FDA has also asked GSK to set up an independent panel of scientists to review the pharma company's clinical trial into the cardiovascular safety of Avandia. A trial comparing Avandia to rival Actos amd other treatments has been stopped. In its interim statement, GSK said it has reached settlements for the majority of the product liability claims relating to Avandia.