Actos (pioglitazone HCl) is an oral agent for type 2 diabetes belonging to the thiazolidinedione (TZD) class of drugs. TZDs help lower insulin resistance, a core dysfunction in people with type 2. They act by helping the body use its available amounts of insulin more effectively. Actos is known as an “insulin sensitizer” because it directly targets insulin resistance, a condition in which the body cannot use the insulin it produces efficiently.

As an adjunct to diet and exercise, Actos can help improve blood glucose levels in patients with type 2. It helps the body become more sensitive to the insulin it produces. Actos is taken once a day without regard to meals, and it can be used alone or in combination with insulin, metformin or sulfonylureas.

For more information on pioglitazone, please see the complete prescribing information available by visiting the Actos Web site at

  • Actos can cause fluid retention that may lead to or worsen heart failure, so tell your doctor if you have a history of these conditions.
  • If you have moderate to severe heart failure, Actos is not recommended.
  • Talk to your doctor immediately if you experience nausea, vomiting, stomach pain, tiredness, loss of appetite, dark urine or yellowing of the skin.
  • People taking Actos may experience flu-like symptoms, mild to moderate swelling of legs and ankles and anemia.
  • When taking Actos with insulin or sulfonylureas, you may be at risk for low blood glucose
  • Your doctor should perform a blood test to check for liver problems before you start Actos and periodically thereafter.

Source: Takeda Pharmaceuticals

Mehmood Khan, MD, FACE, is the senior vice president for medical and scientific affairs at Takeda Pharmaceuticals North America

Five years after its FDA approval, how has Actos revolutionized how type 2s treat their condition?

Up until the last five or six years, we had only two classes of diabetes pills: sulfonylureas and metformin. Actos itself, among all diabetes agents, has a unique clinical profile. It is a therapy that addresses both insulin resistance and also has a significant and unique effect on diabetic dyslipidemia—a significant contributor to cardiovascular disease—that is present in the majority of patients with diabetes. Actos offers clinicians and patients not only the ability to improve BGs but also blood lipids. That is not possible with any other agent. It’s truly a unique profile.

Who is the ideal candidate in the type 2 population for taking Actos, and why?

I think the ideal candidate is someone who has type 2 and has insulin resistance. Their body is producing some insulin, but the insulin isn’t able to work in the tissue. Patients with insulin resistance respond favorably to Actos.

Does Actos have an almost statin-like quality?

Statins target LDL cholesterol. In fact, their effect on triglyceride and HDL is modest and variable. Diabetic dyslipidemia—by definition—does not mean an increased LDL. Diabetic dyslipidemia is a high triglyceride and a low HDl. And it is that abnormality that is improved with Actos. So, the effect of Actos would be considered to be complementary to a statin—not the same. Actos can be taken in patients who are also taking a statin. And some patients need both.

Takeda announced it has submitted a New Drug Application for a new oral medication that combines Actos and glimepiride. What about this combination is unique and beneficial to people with diabetes?

We actually have two NDAs filed. One for Actos in combination with glimepiride and the other for a combination with metformin. The ability to combine them in one pill adds convenience and helps with adherence. Second, combining the two into one pill means only one co-pay instead of two.

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