If you have type 2 diabetes, you may need to take medication. One option is pioglitazone (Actos).
While this drug can help manage your blood sugar levels, it may cause you to gain weight. However, there are some ways to help manage your weight effectively.
How does pioglitazone work for type 2 diabetes?
Pioglitazone (Actos) belongs to a class of medications called thiazolidinediones. They affect how your body handles insulin and glucose.
When you eat and drink, your body converts carbohydrates into glucose, a type of sugar. Insulin is a hormone your pancreas produces to help cells absorb and use the glucose for energy.
If you have type 2 diabetes, your body does not use insulin effectively or make enough of it. This can lead to high blood sugar levels.
Pioglitazone can help by making your cells more responsive to insulin and better regulating how much glucose enters your bloodstream.
Does pioglitazone cause weight gain?
Weight gain is a possible side effect of pioglitazone (Actos).
According to a 2023 article, there are several possible reasons this medication might make you gain some extra weight. Some of these may include:
- Fluid retention: The drug can make your body hold on to more water.
- Increased fat storage: It can prompt your body to store more fat.
- Increased food intake: Thiazolidinediones affect your central nervous system and can make you feel like eating more food than usual.
An article from 2019 found that taking pioglitazone (Actos) typically causes people to gain 4.4–6.6 pounds of fat in 1 year.
What are the risk factors for weight gain?
Whether you gain weight while taking this medication depends on many factors.
Firstly, your dosage can play a role, with higher doses often leading to a greater weight gain.
Secondly, lifestyle factors can also affect your weight, but this may happen regardless of your medications, as consuming more calories than your body burns will lead to weight gain.
To help prevent weight gain, try to balance the calories you consume with the amount you burn. You can work with a healthcare professional, like a registered dietitian, for tailored advice on achieving this. For instance, they may recommend keeping a food and exercise diary to gain insights into how many calories you consume and burn over a number of weeks.
Pioglitazone side effects
Besides weight gain, thiazolidinediones like pioglitazone (Actos) may have other side effects.
According to a 2023 article, these can include:
- Fluid retention and edema: Up to 20% of people taking this medication will experience water retention. In addition to contributing to weight gain, it can increase your blood volume to a dangerous level. So, you may need to take diuretics alongside pioglitazone to help your body remove excess fluid. For this reason, there is a black box warning that pioglitazone may cause or worsen heart failure.
- Weakened bones: This medication may reduce bone density, making them more susceptible to breaking.
- Increased ovulation: Pioglitazone can make people with a uterus ovulate more, including those who are premenopausal or live with polycystic ovarian syndrome. If you don’t plan to get pregnant, it’s important to use birth control while taking this medication.
Additionally, this medication may not be suitable during pregnancy and for people who take specific medications called cytochrome inducers, like phenobarbital.
Pioglitazone (Actos) may also be unsuitable if you have:
- heart failure
- liver disease
- bladder cancer
- osteoporosis
If you or your family have a medical history of these conditions or experience any of the side effects above, discuss your concerns with a healthcare professional. They can help you find the best way to manage your treatment.
How to manage weight while taking pioglitazone
The typical starting dose for pioglitazone (Actos) is 15 milligrams (mg) once daily, and the maximum is 45 mg once daily.
One way to help minimize weight gain is to take less than 30 mg of pioglitazone per day.
You can also help minimize weight gain and fluid retention by taking pioglitazone (Actos) with the following medications:
- sodium-glucose transport protein 2 (SGLT2) inhibitors
- glucagon-like peptide-1 receptor agonists (GLP-1 RAs)
- metformin
We look at these medications in more detail in the “Alternatives” section of this article.
However, it’s important not to change your dosage or start taking additional medications without first discussing it with a prescribing healthcare professional.
Lifestyle modifications
Besides medication changes, you can adopt lifestyle strategies to help you maintain or reach a moderate weight. For example, 2023 guidelines on weight management for the prevention and treatment of type 2 diabetes suggest:
- A reduced calorie diet: Eating fewer calories than your body burns is key to weight loss. There are many ways to achieve this. You can work with a healthcare professional like a registered dietitian to find an approach you enjoy and can stick to long term.
- Regular physical activity: Exercising more often can support a calorie deficit and promote weight loss or maintenance. Aim for at least 200–300 minutes of physical activity per week.
- Behavioral therapy: Working with a mental health professional can help create and maintain behavior changes that support a moderate weight.
- Surgery: If medication, therapy, and lifestyle changes haven’t worked for you, and you live with obesity, a healthcare professional may suggest surgical options, like a gastric bypass or sleeve gastrectomy.
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