.

Chapters

0:09 Introduction
0:25 Uses
1:05 Doses
1:48 side effects
2:39 Warnings




Pioglitazone, sold under the brand name Actos among others, is an anti-diabetic medication used to treat type 2 diabetes.[2] It may be used with metformin, a sulfonylurea, or insulin.[2][3] Use is recommended together with exercise and diet.[3] It is not recommended in type 1 diabetes.[3] It is taken by mouth.[3]

Common side effects include headaches, muscle pains, inflammation of the throat, and swelling.[3] Serious side effects may include bladder cancer, low blood sugar, heart failure, and osteoporosis.[3][2] Use is not recommended in pregnancy or breastfeeding.[2] It is in the thiazolidinedione (TZD) class and works by improving sensitivity of tissues to insulin.[2]

Pioglitazone was patented in 1985, and came into medical use in 1999.[4] It is available as a generic medication.[2] In 2019, it was the 179th most commonly prescribed medication in the United States, with more than 3 million prescriptions.[5][6] It was withdrawn in France and Germany in 2011.[7][8][9] Pioglitazone is used to lower blood glucose levels in type 2 diabetes either alone or in combination with a sulfonylurea, metformin, or insulin.[1] The effects of Plioglitazone have been compared in a Cochrane systematic review to that of other blood sugar lowering-medicine, including metformin, acarbose, and repaglinide, as well as with appropriate diet and exercise, not showing any benefit in reducing the chance of developing type 2 diabetes in people at risk.[10] It did, however, show reduction of risk of developing type 2 diabetes when compared to a placebo or to no treatment.[10] These results should be interpreted considering that most of the data of the studies included in this review were of low or very-low certainty.

While pioglitazone does decrease blood sugar levels, the main study that looked at the medication found no difference in the main cardiovascular outcomes that were looked at.[11] The secondary outcome of death from all causes, myocardial infarction, and stroke were lower.[11]

Pioglitazone has been found to reduce all-cause mortality in type 2 diabetic patients compared to other therapies, with a 60% reduction in mortality in those exposed to pioglitazone, compared to those never exposed.[12] Another study found an all-cause mortality hazard ratio of 0.33 for pioglitazone after adjusting for 40 covariates, compared to insulin.[13] Due to insufficient data on all-cause mortality, cardiovascular mortality, myocardial infarction and stroke, this was not possible to compare in a more recent review.[10]