Actos Side Effects

Actos Side Effects:  Actos, generic name pioglitazone, is a medication used to treat type 2 diabetes, and is in the troubled class of medications called thiazolidinediones, or TZDs.  Actos is available in 15 mg, 30 mg and 45 mg pills.  Actos side effects are generally few in patients who have no congestive heart failure, but because of the cardiac risks associated with the TZDs as a class the use of Actos has become much less popular in the last couple of years.

Black Box Warnings:  Actos and the TZD class of medications can cause or exacerbate congestive heart failure (CHF).  Actos is contraindicated in New York Heart Association Class III-IV patients, and is not recommended in patients with symptomatic CHF.  After initiation or dose increases of Actos, observation for signs and symptoms of CHF is suggested, and if patients develops rapid weight gain, edema, shortness of breath, or other CHF symptoms the CHF should be managed and considering discontinuation of the Actos is recommended.

Common Actos Side Effects:  The most common Actos side effects are related to its propensity to cause fluid retention.  These Actos side effects that are fairly common include edema, fluid retention, weight gain, and dyspnea.  Other common Actos side effects include headache, URI, sinusitis, myalgias, Pharyngitis, dilutional anemia, and hypoglycemia when used in combination with other hypoglycemic drugs.

Serious Actos Side Effects:  As mentioned in the Black Box Warning section CHF is the most common serious Actos side effect.  There is some concern about an increased incidence of bladder cancer with long term Actos use.  Hepatotoxicity, diabetic macular edema and fractures in females taking Actos are other serious Actos side effects.

Cautions and Drug Interactions:  Actos is generally not used in type 1 diabetes, although it is at times used in conjuction with insulin therapy.  Caution is required when Actos is used with insulin.  Actos is contraindicated in NCHA Class III-IV CHF, in symptomatic CHF patients, and caution is advised in patients with edema or known cardiac disease.  Caution is advised in patients with active bladder cancer or a history of bladder cancer.  If the baseline ALT, a liver enzyme, is greater than 2.5 times normal caution is advised.  Actos may induce ovulation and is relatively contraindicated in women on oral contraceptives.  The list of potential drug interactions is extensive, and consultation with your pharmacist or the manufacturer’s guidelines if recommended for a complete evaluation of potential drug interactions.  One commonly used medication with potential drug interactions include gemfibrozil where hepatic metabolism of the Actos may be inhibited.

Pregnancy and Lactation:  Actos is pregnancy category C, and safety in lactation is currently unknown.

Unusual Actos Side Effects:  The fluid retention and CHF risk is somewhat unusual and also serious enough to lead to Actos becoming a less popular medication for the treatment of type 2 diabetes.  The potential for increased risk of bladder cancer is also somewhat unusual and adds to the concern for long term use of Actos for treatment of diabetes.