What to Know About Actos (Pioglitazone)

An Oral Medication for Treating Type 2 Diabetes

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diabetes pills
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Actos (pioglitazone) is an oral medication prescribed for people with type 2 diabetes to help control blood glucose (sugar) levels. It belongs to a class of drugs called thiazolidinediones or, for short, TZDs. Actos works by making muscle and fat cells more sensitive to insulin, a hormone produced by the pancreas that controls the levels of glucose (sugar) in blood. According to the Endocrine Society, Actos also cuts down on the amount of glucose the liver produces. Actos is not a first-line medication for diabetes; most often, it's prescribed along with another pill such as metformin or sulfonylurea and insulin. It's also found in a number of combination drugs, including Oseni (alogliptin, pioglitazone), Actoplus Met® (metformin, pioglitazone), and Duetact (glimepiride, pioglitazone).

Uses

For managing type 2 diabetes, Actos is strictly used as part of a comprehensive treatment plan that includes diet, exercise, and often either insulin or a first-line diabetes medication such as metformin or a sulfonylurea such as chlorpropamide. Because it acts on the body's ability to use insulin, it is not used to treat type 1 diabetes or diabetic ketoacidosis (a complication of type 1 diabetes).

Off-label uses

Actos may help in treating high cholesterol, It's also sometimes prescribed to support ovulation and improve fertility in polycystic ovary syndrome (PCOS).

Before Taking

If you're prescribed Actos as part of your type 2 diabetes management plan, it will be because other treatment measures—a diabetes-centered diet, regular exercise, insulin, and first-line oral medications—haven't been enough to control your blood sugar. The goal of adding Actos is to help you hit the target blood glucose level your doctor has determined is optimal for you.

Your doctor may want to perform a liver function (also known as a hepatic function) test before you begin taking Actos, as advised in the prescribing information for the drug. If you have abnormal results, he or she will want to determine why and, if possible, treat you before you start your Actos prescription, or at least monitor your liver's response to the drug while you're on it.

Actos can cause changes in your blood glucose level that may be lower or higher than is safe. Before you take it, make sure you're able to recognize the symptoms of dangerously low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia).

Precautions and Contraindications

For some people and in certain situations, Actos may not be safe to take or may have the potential to worsen past or existing health problems. Make sure your doctor knows your complete medical history and your current health status. He or she may decide not to prescribe Actos for you or will monitor you carefully while you're on the drug if you:

  • Are a woman and have not yet reached menopause (meaning you've gone a full year without menstruating). Actos may increase the risk of pregnancy even you don't have monthly periods. This is true also if you have PCOS.
  • Are pregnant, planning to become pregnant, or are breastfeeding
  • Have bladder cancer (in which case you absolutely should not take Actos) or have ever had bladder cancer
  • Have a history of diabetic eye disease (retinopathy)
  • Have a history of kidney disease
  • Have a history of liver disease

Women who take Actos have been found in clinical studies to develop fractures of the hands, upper arms, and feet more often than those who did not take pioglitazone, so you may want to take this into consideration.

Actos also carries a boxed warning regarding important risks to people with heart failure (see below).

Dosage

Actos is available as a tablet in three different strengths: 15 milligrams (mg), 30 mg, and 45 mg.

According to the manufacturer, Takeda Pharmaceuticals, when you begin taking Actos, you should start by taking one of the lowest doses—15 mg or 30 mg—once a day.

People who have New York Heart Association Class I or II heart failure should always begin with 15 mg of Actos.

If your initial dosage of Actos isn't high enough to get your blood glucose under control, it can be increased in 15 mg increments up to a maximum of 45 mg taken once a day. Note that it can take up to two weeks for your blood sugar to decrease, and you may not feel the effects for two to three months.

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

How to Take and Store

You can take Actos at any time of day, but try to take it around the same time of day.

If you realize you've forgotten to take your Actos tablet, go ahead and take it, regardless of the time of day. If you don't notice until the following day, skip the missed dose and take the next one at the scheduled time. In other words, don't double up on your dose to try to make up for missing one tablet the previous day.

If you take more Actos than you should at one time, call the poison control helpline (800-222-1222). Although there are no recorded adverse effects of overdosing on Actos, if you (or someone else) take too much of the drug and collapses, has a seizure, has a hard time breathing, or can't be awakened, call 911 right away.

Actos should be stored in a cool-to-room-temperature place, away from light and moisture (which means the bathroom medicine chest isn't a good choice). Keep it in the container it came in so that you don't mistake it for another medication, with the lid on tightly, and make sure it's well out of reach of children or pets.

Side Effects

As with most medications, taking Actos comes with the risk of side effects. Some are common and tend to be mild and easy for most people to deal with; however, some potential side effects of the drug can be severe and intolerable, or even lead to permanent health problems.

Common

Common side effects of Actos (regardless of dose) include:

  • Headache
  • Upper respiratory tract infection
  • Sinusitis
  • Myalgia (muscle aches) or pain in the arms or legs
  • Pharyngitis (sore throat)
  • Flatulence (gas)

Severe

There are a few more serious adverse side effects associated with Actos. Let your doctor know immediately if you experience any of these symptoms while taking Actos:

  • Changes in or loss of vision
  • Frequent, painful, or difficult urination
  • Cloudy, discolored, or bloody urine
  • Back or stomach pain

Some people who take Actos develop liver problems. Stop taking the drug right away and call your doctor if you experience:

  • Nausea or vomiting
  • Appetite loss
  • Pain in the upper right area of your stomach
  • Flu-like symptoms
  • Dark urine
  • Jaundice (yellowing of the skin or whites of the eyes)
  • Unusual bleeding or notice you bruise easily
  • Fatigue

Warnings and Interactions

Actos carries a boxed warning about the drug's potential to cause or worsen heart failure—a condition in which the heart is unable to pump enough blood to the other parts of the body. There are four classifications of heart failure, based on symptoms and degree of disability, according to the New York Heart Association. People who have Class 1 or Class II heart failure, in which symptoms are nonexistent or mild, and who have little disruption of physical ability, may take Actos. The drug is contraindicated for people with Class III or Class IV heart failure who must limit activity and are only comfortable while at rest or in a chair or bed.

If you have Class I or Class II heart failure, you must start on the lowest dose per the prescribing information and be monitored carefully for signs of heart failure. Tell your doctor immediately if you have any of the following symptoms, especially when you first start taking pioglitazone or after your dose is increased:

  • Excessive weight gain in a short period of time
  • Dyspnea (shortness of breath)
  • Waking up short of breath during the night
  • Edema (swelling of the arms, hands, feet, ankles, or lower legs)
  • Swelling or pain in the stomach
  • Needing to extra pillows in order to breathe while lying down
  • Frequent dry cough or wheezing
  • Difficulty thinking clearly; confusion
  • Fast or racing heart
  • Lowered ability to walk or exercise
  • Increased fatigue

Also tell your doctor if you were born with a heart defect, and if you have or have ever had edema; heart disease; high cholesterol or elevated blood fats; high blood pressure; coronary artery disease (narrowing of the blood vessels that supply blood to the heart); a heart attack; an irregular heartbeat; or sleep apnea. Your doctor may tell you not to take pioglitazone or may monitor you carefully during your treatment.

Alcohol may cause a decrease in blood sugar. If you drink, ask your doctor if there's a safe level of alcohol you can drink while on Actos.

Actos may interact with certain medications, including Lipitor (atorvastatin), Lopid (gemfibrozil), hormonal contraceptives), insulin or oral diabetes medications ; (Nizoral (ketoconazole), midazolam, Procardia (nifedipine), Zantac (ranitidine) Rifadin (rifampin) and Elixophyllin (theophylline). If you take any of these, your doctor may change your dose or monitor you for side effects while you're on Actos.

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