What to Know About Actos (Pioglitazone)

An Oral Medication for Treating Type 2 Diabetes

Close up of blood sugar measurement devices and pills

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In This Article

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 known as thiazolidinediones (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. Actos also cuts down on the amount of glucose the liver produces.

Actos is not a first-line treatment 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 other medications (such as insulin or a first-line diabetes drug such as metformin or a sulfonylurea). Because it acts on the body's ability to use insulin, Actos is not used to treat type 1 diabetes or diabetic ketoacidosis (a complication of type 1 diabetes).

Off-Label Uses

Actos may be used off-label to treat high cholesterol. Actos is also sometimes prescribed to improve fertility in women with polycystic ovary syndrome (PCOS). When used with metformin, Actos has been shown to normalize menstrual cycles in 50% of women with PCOS within six months.

Before Taking

If you're prescribed Actos as part of your type 2 diabetes management plan, it is because other treatment measures 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 may want to perform a liver function test before taking Actos. If you have abnormal liver enzymes, treatment may be delayed until your liver condition is treated or your doctor may monitor your condition to ensure the liver remains unharmed.

Precautions and Contraindications

Actos may not be safe for people with certain health problems. Make sure your doctor knows your complete medical history before starting treatment. The doctor may need to monitor your condition or avoid treatment if you have or have had any of the following:

  • Bladder cancer
  • Diabetic eye disease
  • Kidney disease
  • Liver disease

The same may apply if you are in your childbearing years. Actos can increase the risk of pregnancy even you don't have regular monthly periods.

Actos is classified as a Pregnancy Category C drug, meaning that no well-controlled studies have been conducted in humans but that the benefits of treatment may outweigh the risks.

Women who take Actos are at an increased risk of bone fractures. According to a 2016 study in the Journal of Clinical Endocrinology & Metabolism, women who take Actos for five years have a 53% risk of fractures, mainly of the hands, upper arms, or feet.

Dosage

Actos is available as a tablet in three different strengths: 15 milligrams (mg), 30 mg, and 45 mg. When you first start Actos, you should begin with one of the lower doses—15 mg or 30 mg—once daily. If you respond well to this initial dose, you can increase incrementally up to 45 mg once daily.

If your initial dose 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 daily. It can take up to two weeks for your blood sugar to decrease, and you may not feel any significant effects for two to three months.

Actos should be used with caution in people with mild heart failure and only if the benefits outweigh the risk. In people with moderate to severe heart failure, Actos should be avoided without exception.

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 forget to take your Actos dose, go ahead and take it regardless of the time of day. If you don't remember until the following day, skip the missed dose and take the next one as scheduled. In other words, don't double up doses to make up for missing yesterday's dose.

Actos should be stored in a cool place away from light and moisture. (A bathroom medicine chest isn't a good choice.) Keep it in its original light-resistant container, and make sure it's out of reach of children or pets.

If you take more Actos than you should at one time, call the Poison Control Helpline at 800-222-1222.

Side Effects

As with most medications, Actos can cause side effects. Some are mild and easy to deal with. Others are severe and can lead to permanent health problems.

Common

Common side effects of Actos include:

  • Headache
  • Upper respiratory tract infection
  • Sinusitis
  • Myalgia (muscle aches)
  • Pharyngitis (sore throat)
  • Flatulence (gas)

Severe

There are a few more serious adverse side effects associated with Actos. Let your doctor know if you experience any of the following 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 eyes)
  • Unusual bleeding or bruising
  • Fatigue

Warnings and Interactions

In 2007, the U.S. Food and Drug Administration (FDA) issued a black box warning advising doctor and consumers that Actos may cause heart failure in certain people. The advisement went on to describe who can and cannot take Actos based on four classifications of heart failure outlined by the New York Heart Association (NYHA).

People who have NYHA Class I or Class II heart failure (in which symptoms are mild to nonexistent and do not impair physical ability) may take Actos. The drug is contraindicated for people with Class III or Class IV heart failure (in which physical activity is limited).

To avoid serious treatment-related complications, call your doctor immediately if you have any of the following symptoms while taking Actos:

  • 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

Let your doctor if you were born with a heart defect, and if you have or ever had edema, heart disease, high blood pressure, coronary artery disease, heart attack, irregular heartbeat, or sleep apnea.

Interactions

Actos can 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).

Interactions can often be avoided by separating drug doses by several hours. In other cases, a drug may need to be substituted or a dose adjusted.

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

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Article Sources

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