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Actos (pioglitazone HCl) is an oral, antidiabetic prescription medication intended to improve glycemic control (regulation of blood sugar) for the clinical treatment of Type 2 Diabetes, which is characterized by insulin resistance (a metabolic condition where the insulin produced in the body is no longer working properly and blood sugar levels become elevated).
Actos is prescribed with the intention of controlling blood sugar levels (in conjunction with diet and exercise) by helping insulin, a pancreatic hormone that regulates blood sugar in healthy individuals, work better in muscle and fat tissues and also reduce glucose production in the liver.
Actos is not prescribed for treatment of type 1 diabetes, a condition in which the body does not produce insulin, or diabetic ketoacidosis, a serious life-threatening metabolic condition that develops when the body does not produce enough insulin and breaks down fatty acids into toxic ketone bodies.
The FDA issued a black box warning for the US starting in 2007. An Actos recall has been issued in both France and Germany.
Actos and Thiazolidinediones
Actos, or pioglitazone HCl, is a member of the thiazolidinediones, one of six classes of antidiabetic drugs that work to lower blood sugar levels in the body by increasing sensitivity to insulin. These drugs bind to an intracellular protein (PPARγ) that regulates a host of genes involving proteins that manage sugar and fat metabolism. Other members of this class include Avandia (rosiglitazone, GlaxoSmithKline) and Rezulin (troglitazone, Parke-Davis). Rezulin was removed from the US market in March of 2000 after causing serious liver damage in patients who were taking the drug.
Classes of Antidiabetic Drugs
- biguanides (e.g., metformin)
- sulfonylureas (e.g., glimepiride)
- meglitinides (e.g., repaglinide)
- thiazolidinediones (e.g., pioglitazone)
- dipeptidyl peptidase IV inhibitors (e.g., sitagliptin)
- α-glucosidase inhibitors (e.g., acarbose)
Pioglitazone and Brand Names
Actos may be taken alone or as a combination therapy with other oral antidiabetic drugs under the brand names ACTOplus MET® (15 mg pioglitazone HCl and 500mg metformin HCl), ACTOplus MET® XR (15 mg pioglitazone HCl and 850 mg metformin HCl extended-release), or duetact® (30 mg pioglitazone HCl and 2-4mg glimepiride).
Actos is indicated as an adjunct to diet and exercise to improve control of blood sugar levels in adults with type 2 diabetes mellitus in multiple clinical settings. Actos should be taken once daily and can be taken without meals. Liver tests should be performed before you begin taking Actos. Routine testing is not necessary unless your initial tests are abnormal or you have a prior liver condition. Inform your physician if any adverse reactions or side effects occur.
Congestive Heart Failure and Actos Contraindications
Actos should NOT be used in patients with congestive heart failure (characterized as NYHA Class III or IV) or patients with a history of a serious hypersensitivity (allergic) reaction to Actos or any of its ingredients. Certain conditions can limit the use of Actos or may prevent the use of Actos completely.
You should inform your physician if any of these conditions exist.
- Congestive heart failure
- Type 1 (“juvenile”) diabetes
- History of diabetic ketoacidosis
- Macular edema (diabetic eye disease that causes swelling in the back of the eye)
- Pre-existing liver problems
- Women who are pregnant or plan to become pregnant
- Premenopausal women who do not have periods regularly or at all
- Women who are breastfeeding or plan to breastfeed
Interactions with Diabetes Drugs and Supplements
In some cases, it may become necessary to take more than one medication at a time. This may increase the risk of certain side effects. Please consult your physician before taking multiple medications. If an interaction between drugs occurs, your physician may need to adjust the dosage to decrease these risks. Inform your physician of any medications, both prescription and over-the-counter, that you are taking. This includes nutritional supplements used for diabetes.
Some of these medicines include:
- Oral Contraceptives (birth control pills)
- Ketoconazole (anti-fungal drugs)
- Atorvastatin calcium (cholesterol-lowering drugs)
- Gemfibrozil (lipid-lowering drugs)
- Rifampin (antibacterial drugs)
- Fiber supplements (Metamucil or psyllium, glucomannan)