Actos (pioglitazone) may control blood sugar levels in older diabetics better than metformin, but it still carries risks that patients should weigh before taking the drugs, said a medical expert for AARP.org.
Actos is a medication used to treat type 2 diabetes. Actos is similar to Avandia (rosiglitazone), and both drugs are in a class of medications known as thiazolidinediones (TZDs). Whether used alone or with other antidiabetic agents, TZDs can cause or worsen heart failure.
In 2010, the Food and Drug Administration (FDA) severely restricted the use of Avandia because of the cardiovascular risk, but the agency did not put the same restrictions on Actos. Still, people with heart failure should not use TZDs and those with risk factors for heart failure – such as high blood pressure, coronary artery disease, a history of heart attacks, or irregular heartbeats – should use them with caution.
TZDs also carry another serious risk. An analysis of five-year results from an ongoing study found that people who used TZDs were at risk for developing bladder cancer. Last year, the FDA issued a warning that Actos had been associated with an even greater risk for bladder cancer.
Metformin is often considered the treatment of choice for older diabetics, but AARP.org reports that this is often a wrong choice for that population, who typically lack the ability to flush the drug out of their kidneys before they accumulate toxic levels. “Because pioglitazone (Actos) is metabolized in the liver, not the kidneys, it’s typically the best way to control type 2 diabetes in older patients.”
Diabetics who decide that Actos is the best approach should be aware of the signs and symptoms of heart failure and bladder cancer, and contact their health care professional if they have any concerns.