actos

Actos is the brand name for pioglitazone, a thiazolidinedione antidiabetic medication. It is used to improve glycemic control in adults with type 2 diabetes as an adjunct to diet and exercise. It can be used as monotherapy or in combination with other antidiabetic agents, including metformin, sulfonylureas, or insulin. Actos is produced by Takeda Pharmaceutical Company and is also available as generic pioglitazone.

Mechanism of action: Pioglitazone is a peroxisome proliferator-activated receptor gamma (PPAR-γ) agonist. Activation of PPAR-γ increases insulin sensitivity in adipose tissue, muscle, and liver, leading to improved glucose uptake and reduced hepatic glucose production.

Dosing and administration: Typical starting dose is 15 mg once daily, with possible uptitration to 30 mg after 3–4 weeks if glycemic control is not adequate, and to a maximum of 45 mg daily. Dosing may be adjusted for certain patients, and it is generally avoided in patients with significant hepatic impairment or active liver disease. Baseline and periodic liver function tests are recommended due to rare risk of hepatotoxicity. It is not indicated for type 1 diabetes or diabetic ketoacidosis.

Safety and side effects: Common adverse effects include edema, weight gain, headache, and upper respiratory tract infection. Pioglitazone may increase the risk of congestive heart failure, particularly when combined with insulin or in patients with preexisting heart failure. Long-term use has been associated with an increased risk of bladder cancer in some studies, and with bone fractures, notably in women. Macular edema has been reported. Use during pregnancy is not recommended.

Regulatory and monitoring notes: Use with caution in patients with heart failure. The drug label recommends monitoring for signs of fluid retention, weight gain, and changes in liver function.