Actos (pioglitazone) is in the thiazolidinedione class of drugs. It has antidiabetic properties which make it useful in helping to treat type 2 diabetes, along with diet and exercise and possibly other antidiabetic medications.

This product improves the function of naturally-occurring insulin. Actos is not suitable for type 1 diabetes, and will not provide benefit for individuals in diabetic ketoacidosis.

Use of Actos in patients under age 18 has not been studied. Speak with a doctor before use if under age 18.

Dosage & Administration

Actos comes in tablets, taken just once per day in the majority of cases. Food is optional according to personal preference.

This medication is most effective when taken long term, daily for several months or years. Note there is some controversy about long-term use of Actos, see the controversy section below.

For otherwise healthy patients:

• Start with 15 to 30 mg Actos once per day.
• Dosage may be increased, if needed, in 15 mg increments up to 45 mg per day.

Patients with congestive heart failure:

• Start with 15 mg once per day.
• If well tolerated, and if needed, dosage may be increased up to 45 mg per day.

If taking other antidiabetic medications:

• Dosage should be determined by a doctor.
• Doses of other medications may also be modified if a patient starts taking Actos.

Most patients have good results with Actos, with blood glucose lower and better controlled. Studies have found that death from heart attack, stroke, and other cardiovascular complications are reduced. Taken alone, low blood sugar is a minimal risk with Actos, though this risk is higher if other medications are also being taken.

Controversy

Some European studies have associated Actos, if taken for more than one year, with an increased risk of bladder cancer; some countries have even pulled approval of the medication because of this. Based on these findings, in 2011 in the USA a warning about the risk of bladder cancer was added to the product's label in compliance with FDA rules.

However, other studies have found no association between Actos and increased development of bladder cancer. Many of these studies are newer than the European studies by several years. Still more studies are ongoing.

In summary, it's very difficult to say who---if anyone---is right in this instance. Patients will need to decide for themselves if trying Actos is worth the potential risk, and discussing the issue with a doctor may also prove insightful.

Avoiding Actos if one already has bladder cancer, or is at high risk of developing bladder cancer, is generally recommended, however.

Precautions

Not everyone is the ideal candidate for Actos. Be sure the prescribing doctor is aware if there is any history of or high risk of:

• Heart attack
• Stroke
• Congestive heart failure
• Liver impairment
• Bladder cancer
• Diabetes-related eye problems

The above don't necessarily rule out Actos use, but they might---there are alternative treatments that may be less risky for some individuals.

Women taking Actos may be more likely to break bones. A doctor may decide Actos is not the best medication for women with poor bone health, and a doctor can also discuss methods to improve bone health.

This medication can be used if pregnant if deemed necessary, though it's possible other treatments will take Actos's place while pregnant or breastfeeding. Dosage may also need to be modified during pregnancy, as controlling diabetes is also very important.

Actos should not be used by patients under 18 years of age without explicit doctor approval.

Side Effects

Most side effects from Actos in otherwise healthy patients are mild and not cause for concern unless severe persistant past the first few weeks of treatment, including:

• Headache
• Increased tooth sensitivity
• Muscle pain
• Sinus pain or pressure
• Sore throat
• Sneezing

More rare, but more serious, side effects can also develop. Seek medical attention if experiencing:

• Blurry vision
• Pain in hands, feet, or arms
• Difficulty urinating
• Pink or red urine
• Shortness of breath
• Fatigue
• Edema

Other medications---including other antidiabetic medications---can interact with Actos and cause potentially severe complications. Be sure the prescribing doctor is aware of all other medications being taken, and double-check with a doctor before adding, removing, or modifying dosage of any other medications.