Actos

Medically reviewed by Dena Westphalen, PharmD on May 30, 2023
Written by Alex Brewer, PharmD, MBA

This article describes pioglitazone’s uses, side effects, and more. Below you’ll also find some coupon options to help save on the cost of pioglitazone.

Boxed warning: Risk of congestive heart failure

Pioglitazone has a boxed warning about the risk of congestive heart failure. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

For details, see the “Interactions and warnings for pioglitazone” section below.

Pioglitazone may cause mild or serious side effects (also known as adverse effects). More common mild side effects of pioglitazone and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about pioglitazone’s side effects, talk with your doctor or pharmacist. You can also read the prescribing information* for pioglitazone.

* To view pioglitazone’s prescribing information, see the “Article resources” section below.

Mild side effects

More common mild side effects reported with some forms of pioglitazone are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about pioglitazone’s side effects, see the prescribing information* for pioglitazone.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Pioglitazone oral tablet’s mild side effects include:

• upper respiratory infection, such as the common cold
• headache
• sinus infection
• muscle aches and pain
• fluid retention (increased fluid buildup in the arms and legs)
• mild allergic reaction†

† To view pioglitazone’s prescribing information, see the “Article resources” section below.

Serious side effects

Serious side effects of pioglitazone are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about pioglitazone’s side effects, see the drug’s prescribing information.*

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, pioglitazone’s serious side effects include:

• liver side effects, including liver failure
• possible increased risk for bladder cancer
• increased risk of broken bones
• diabetic macular edema (increased fluid in the eye that can cause vision problems)
• boxed warning: risk of congestive heart failure†
• severe allergic reaction†

* To view pioglitazone’s prescribing information, see the “Article resources” section below.
† For details about this side effect, see the “Interactions and warnings for pioglitazone” section below.

Below you’ll find answers to a few commonly asked questions about pioglitazone.

What brand names are available for pioglitazone?

Pioglitazone tablets are available as the brand-name drug Actos.

For more information about taking brand-name Actos instead of generic pioglitazone, talk with your doctor or pharmacist.

Is it safe to take pioglitazone with metformin?

Yes, if your doctor says it’s safe for you to do so.

Studies showed that taking pioglitazone and metformin together is effective for managing high blood sugar caused by type 2 diabetes in adults.

That said, both metformin and pioglitazone can cause liver-related side effects. An example is liver failure, which is rare but can be serious.

Your doctor can help determine whether it’s safe for you to take pioglitazone and metformin together based on your liver health and other factors.

Can pioglitazone be used for fatty liver?

Pioglitazone is not approved for treating fatty liver. However, doctors may still prescribe the drug off-label for this use. Off-label refers to prescribing a drug to treat a condition that isn’t an approved use.

Talk with your doctor to learn more about possible off-label uses for pioglitazone.

Does pioglitazone cause weight loss?

No, pioglitazone does not cause weight loss.

In fact, the drug caused weight gain as a side effect in some people in studies of the drug.

Talk with your doctor if you have concerns about your weight. If you notice quick weight gain (such as gaining five pounds over a few days) while taking pioglitazone, contact your doctor right away. This may be a sign of fluid retention, which can be a side effect of pioglitazone or an early warning symptom of heart failure.*

* Pioglitazone has a boxed warning about the risk of congestive heart failure. For details, see the “Interactions and warnings for pioglitazone” section below.

How does pioglitazone work? And how long does it take to start working?

Pioglitazone works to lower blood sugar levels by helping insulin work better. Insulin is a hormone your body makes naturally. Usually, insulin sends sugar out of your blood and into your cells to use as energy. But in people with type 2 diabetes, insulin doesn’t work as well as usual.

It can take several weeks before pioglitazone causes long-term changes in your blood sugar. Talk with your doctor to learn more about how they’ll monitor how well pioglitazone is working for you.

Are kidney-related side effects possible with pioglitazone?

No, pioglitazone isn’t known to cause kidney-related side effects.

Type 2 diabetes can cause kidney harm, especially if not managed correctly. There are some drugs used to treat type 2 diabetes that can cause kidney-related side effects. But according to pioglitazone’s studies, kidney-related side effects weren’t reported.

Talk with your doctor or pharmacist if you’d like to know whether any of your medications could cause kidney-related side effects.

The Food and Drug Administration (FDA) approves prescription drugs such as pioglitazone for certain conditions. Approved uses for pioglitazone are described below.

Use for type 2 diabetes

Doctors may prescribe pioglitazone oral tablet to help manage high blood sugar caused by type 2 diabetes. It’s prescribed for this purpose for adults. It’s usually prescribed as a long-term treatment.

Type 2 diabetes is characterized by sugar (glucose) levels building up in your blood. Usually, your body releases the hormone insulin when the amount of glucose in your blood becomes high. Insulin moves glucose out of your blood and into your cells, so your body can use glucose for energy.

But in people with type 2 diabetes, your body’s cells stop responding to insulin or don’t respond as well. Over time, your body may not make enough insulin or stop producing it entirely. When your body stops responding to or stops making insulin, your blood sugar levels become high. Over time, high blood sugar can cause damage throughout your body, including harming your heart, eyes, and kidneys.

Symptoms of type 2 diabetes can include:

• increased thirst
• increased appetite
• fatigue (low energy)
• urinating more frequently than usual

Pioglitazone is prescribed together with lifestyle changes, including diet and exercise, to lower blood sugar levels. It may also be used with other medications for type 2 diabetes but can be used without them.

Doctors may not prescribe pioglitazone oral tablet in certain situations, such as for:

• treating type 1 diabetes. Pioglitazone isn’t approved to treat type 1 diabetes.
• treating diabetic ketoacidosis (DKA). DKA is a potentially life threatening emergency that requires immediate treatment in a hospital or emergency room.

Below, you’ll find information about pioglitazone’s possible interactions and warnings.

Interactions of pioglitazone

For some medications, certain things may affect how the drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take pioglitazone, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription drugs
• over-the-counter medications
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Interactions and warnings for pioglitazone” section below.

Warnings for pioglitazone

Some people should not take pioglitazone, and others should use it cautiously.

Boxed warning: Risk of congestive heart failure

Pioglitazone has a boxed warning about the risk of congestive heart failure. Boxed warnings are serious warnings from the Food and Drug Administration (FDA).

Heart failure is a condition where your heart struggles to pump blood throughout your body properly. While rarely reported in studies of pioglitazone, heart failure is a serious condition that requires long-term treatment.

Symptoms of heart failure can include:

• shortness of breath
• fatigue (low energy)
• weight gain, especially unintended weight gain over a short time
• a cough that doesn’t go away
• exercise intolerance

Pioglitazone may also worsen heart failure in people who already have this condition. Due to this risk, doctors typically won’t prescribe pioglitazone to people with heart failure of a certain severity. Talk with your doctor to learn more about the severity of your heart failure and whether it’s safe for you to take pioglitazone.

If you experience symptoms of heart failure, tell your doctor immediately. They’ll likely recommend lowering your pioglitazone dose or stopping treatment with the drug. They may also recommend a treatment for your symptoms, such as a medication for treating heart failure.

To learn more, talk with your doctor or pharmacist.

Other warnings

Pioglitazone could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether pioglitazone is a safe option for you.

Ask your doctor about specific warnings for pioglitazone, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Pioglitazone can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to pioglitazone or any of its ingredients, your doctor will likely not prescribe pioglitazone. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to pioglitazone, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Pregnancy or breastfeeding and pioglitazone

Information about pioglitazone and pregnancy and breastfeeding is described below.

Pioglitazone and pregnancy

It isn’t known if there are risks to taking pioglitazone during pregnancy. But there are known risks with having unmanaged high blood sugar and type 2 diabetes while pregnant. (Keep in mind that pioglitazone is used for managing high blood sugar caused by type 2 diabetes.)

If you’re planning a pregnancy or can become pregnant, talk with your doctor about type 2 diabetes treatment options during pregnancy. Together, you can discuss the risks and benefits of your treatment options and decide whether you should take pioglitazone during pregnancy.

Pioglitazone and breastfeeding

It’s not known whether pioglitazone should be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication.

The dosage of pioglitazone your doctor prescribes may vary based on your condition and certain other factors. Talk with your doctor about the dosage you should take.

Taking pioglitazone

Pioglitazone oral tablet is taken by mouth, with or without food.

Your doctor will talk with you about how to take pioglitazone. They’ll explain how much to take and how often. Always follow your doctor’s recommendation.

Overdose of pioglitazone

You should not take more pioglitazone than your doctor prescribes. For some drugs, doing so may lead to serious side effects or overdose.

If you think you’ve taken too much pioglitazone, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

You may be able to save money on your prescription for pioglitazone by using our Optum Perks discount coupons. They can be found at the end of this article.

If you have questions about how to pay for pioglitazone, talk with your doctor or pharmacist. You can also learn more about the cost of pioglitazone in this article.

Note: Optum Perks coupons cannot be used with insurance copays or benefits.

This article describes pioglitazone’s uses and dosage, ways to save on cost, and more. Let your doctor know if you have questions about pioglitazone or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• Am I at higher risk for side effects from taking pioglitazone based on my medical history?
• If pioglitazone interacts with a medication I take, will my doctor prescribe a lower dose for me?
• How does pioglitazone compare to other medications for treating type 2 diabetes?
• Is there a certain diet I should follow while taking pioglitazone?
• Is there a best time of day to take my pioglitazone dose?

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Pioglitazone tablets for oral use. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/475c4f39-dd2a-48f9-a07c-9344bbda58a9/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.