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What is Actos?

Actos (pioglitazone) is an oral hypoglycemic drug used for the treatment of type 2 diabetes. The drug can be used as a single agent or as part of combination therapy with sulfonamide derivatives, insulin or metformin in the absence of the necessary effect of exercise, diet therapy or monotherapy with one of the above medicines.

How does it work?

Pioglitazone reduces insulin resistance, increases the consumption of insulin-dependent glucose and reduces the release of glucose from the liver, reduces the average TG, increases the concentration of HDL and cholesterol. Unlike sulfonylureas, pioglitazone does not stimulate insulin secretion. The drug selectively stimulates peroxisome proliferator-activated gamma receptors (PPAR).

How should I use Actos?

The drug is taken orally 1 time per day (regardless of the meal).

  • Monotherapy: 15-30 mg; the maximum daily dose is 45 mg;
  • Combination therapy: sulfonylurea derivatives, metformin – treatment with pioglitazone starts with a dose of 15 mg or 30 mg (if hypoglycemia occurs, reduce the dose of sulfonylurea or metformin);
  • Treatment in combination with insulin: the initial dose is 15-30 mg/day, the insulin dose remains the same or decreases by 10-25% (if the patient reports hypoglycemia or the plasma glucose concentration is reduced to less than 100 mg/dL).

What are the contraindications of this medicine?

Do not use Actos in the presence of any of the following conditions:

  • type 1 diabetes;
  • diabetic ketoacidosis;
  • severe heart failure of the III-IV functional class according to the NYHA classification;
  • pregnancy;
  • lactation (breastfeeding);
  • age up to 18 years;
  • hypersensitivity to pioglitazone.

The drug should be used with caution in patients with edematous syndrome, anemia, liver failure (an increase in the activity of liver enzymes), mild and moderate heart failure.

What are the side effects of Actos?

  • Endocrine system: hypoglycemia;
  • Hemopoietic system: anemia, a decrease in hemoglobin and hematocrit, which are observed mainly 4-12 weeks after the start of treatment and remain relatively constant (not associated with any clinically significant hematological effects and most often due to an increase in plasma volume);
  • Metabolism: edema, increase in body weight, increased activity of CPK;
  • Digestive system: hepatitis;
  • Organ of vision: development or progression of diabetic macular edema, accompanied by a decrease in visual acuity.

What may interact with this medicine?

  • Ketoconazole inhibits the metabolism of pioglitazone;
  • Actos may reduce the effectiveness of oral contraception.

What should I watch for while using this medicine?

An overdose of Actos in monotherapy is not accompanied by specific clinical symptoms. An overdose of Actos in combination with a sulfonylurea drug may be accompanied by symptoms of hypoglycemia. Treatment should be symptomatic, depending on the clinical manifestations. There is no specific antidote.

The development of hypoglycemia in combination therapy necessitates a reduction in the dose of concomitant sulfonamides or insulin. Dose adjustment is not required against a background of renal failure.

It is necessary to discontinue treatment if jaundice occurs.

The drug can cause ovulation and increase the risk of pregnancy in women with the anovulatory cycle in the premenopausal period – contraception is required.