Alternatives and Substitutes to Actos for Diabetes Patients


Because Actos is linked to serious side effects including bladder cancer, doctors may recommend alternatives to Actos including other oral and injectable medications.

Actos, manufactured by Takeda Pharmaceuticals, is the brand name for pioglitazone, an oral drug used to control blood sugar in people with Type 2 diabetes. Actos is the most recent drug from a class known as thiazolidinediones (TZDs), which work by making the body more sensitive to insulin. The drugs in this class are sometimes referred to as “insulin sensitizers.”

Actos is prescribed, along with lifestyle changes, such as increased exercise, weight loss and smoking cessation.

Four Therapy Combinations
When physicians decide to use Actos for their patients, they can prescribe it in one of four therapy combinations:
Monotherapy – Actos is the only agent the patient will use to control blood sugar.
In combination with sulfonylureas –  This second drug class helps control blood sugar by increasing the amount of insulin the pancreas produces.
In combination with metformin – The most common brand name for metformin is Glucophage, and it works by decreasing the amount of sugar the liver produces, increasing the amount of sugar the cells absorb, and decreasing the body’s need for insulin.
In combination with insulin.

Actos Side Effects

The Food and Drug Administration (FDA) reviewed five years of data from an ongoing study of 193,099 diabetes patients who were treated with pioglitazone for an average of two years. The analysis showed that study participants who took Actos for more than a year had a 40 percent increased risk for bladder cancer.

In May 2012, a study published in the British Medical Journal linked use of Actos to an 83 percent increase in the risk of bladder cancer.

In addition, pioglitazone can cause or worsen congestive heart failure. This is a medical condition in which the heart cannot adequately pump enough blood to meet the body’s needs. Other serious side effects associated with the drug are bone fracture and blurred vision.

Because of these dangerous side effects, doctors increasingly are choosing to prescribe an alternative medicine instead of Actos.

Alternatives to Actos

Metformin and sulfonylureas such as Glimepiride (brand name Amaryl), Glipizide (brand name Glucotrol), and Glyburide (brand name DiaBeta) can be substituted for Actos. They can either be used alone or with another medication.

Other drug classes that are taken orally and may be safer substitutes include:
Repaglinide (brand name Prandin) — works by increasing the pancreas’s insulin production
Acarbose (brand name Precose) — works by stopping the breakdown of carbohydrates in the digestive tract so they cannot be absorbed by cells.
Saxagliptin (brand name Onglyza) — works by breaking down incretin hormones, which increases the pancreas’s insulin production and decreases the liver’s sugar production.
Additional substitutes taken by injection include:
Insulin mimetics — These drugs affect the cells in the same way that insulin does by breaking down incretin hormones, which produces more insulin and lessens the liver’s production of sugar. Liraglutide (brand name Victoza) is an example of an insulin mimetic.
Amylin Analogues — This drug affects the cells like the hormone amylin does by increasing insulin production, slowing digestion so the cells cannot absorb carbohydrates, decreasing the amount of glucose produced by the liver, and reducing appetite. There is one FDA-approved amylin analogue, pramlintide (brand name Symlin).
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