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12 top questions about pioglitazone, answered

12 top questions about pioglitazone, answered

Optum Perks Author

By Optum Perks Author

If you have type 2 diabetes and are having trouble controlling your blood sugar levels, your physician may prescribe pioglitazone (Actos). This is just one of many medications available to help with the condition, so it’s important to understand what it is and how it can help you.

Here to answer your most pressing questions is DeLon M. Canterbury, PharmD, a board-certified geriatric pharmacist in Durham, North Carolina, and CEO of GeriatRx, a service that helps patients and providers make sure prescribed therapies are appropriate, safe and effective.

Q: Why did my doctor choose pioglitazone?

Canterbury:  The truth is, pioglitazone is generally not the first choice of medication for those with type 2 diabetes. But if you have an allergy or intolerance to a more common medications such as metformin, your doctor may want you to try this drug instead. Or, your health care team may look at adding pioglitazone to your prescriptions if you’re not reaching your health goals with metformin alone.

Q: How does pioglitazone work? 

Canterbury:  Pioglitazone is in a group of medications called thiazolidinediones (TZDs). These medications work by increasing your body’s sensitivity to insulin, which controls the amount of glucose (or sugar) in the blood. In short, pioglitazone helps insulin work better in your muscles and fat — and it reduces glucose production in the liver. When your insulin works better, the result is a drop in blood sugar levels.

Q: Why is it important to keep blood sugar levels in check? 

Canterbury:  Over time, untreated high blood sugar from type 2 diabetes can cause serious health problems, such as damaging the vessels that supply blood to your vital organs. That means folks with type 2 diabetes can be at an increased danger of heart disease and stroke, as well as kidney, vision and nerve damage. Taking pioglitazone, along with a healthy diet and exercise, has been shown to help reduce your odds of all of these complications.

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Q: How do I take pioglitazone?

Canterbury:  You usually take your pioglitazone pill(s) once daily. You can take it with or without food, but it’s best to take it at around the same time every day and exactly as prescribed by your doctor.

Q: How long before I see a change?

Canterbury:  You can expect to see changes in your blood sugar after a few weeks on pioglitazone. It can reduce average blood glucose levels (A1C) between 0.3% and 0.9% when used alone. And when pioglitazone is combined with other medications, average A1C levels can be lowered by 0.5% to 1.5%.

Q: What are some common side effects?

Canterbury:  Slow weight gain can happen on pioglitazone, with individuals typically gaining about 2 to 6.5 pounds over a year, according to a 2019 report in the journal Diabetes & Vascular Disease Research. (An important warning: Too much or rapid weight gain is a red flag for heart failure and should not be ignored.)

Some people may also get edema, which is when fluid builds up in the body and causes swelling. Others may get more respiratory tract infections or have eye pain and vision problems while on the medication. One more thing: Pioglitazone can also make women with polycystic ovary syndrome (PCOS) ovulate, which increases the chance of pregnancy.

Q: Any advice for combating weight gain?

Canterbury:  Not everyone on pioglitazone gains weight. It really depends on your baseline weight, the combination of meds you’re on, dosing, what you eat and your exercise habits. If you’re worried about weight gain, speak to your health care team about healthy eating and exercise strategies that may help. Help keep weight gain in check with these 21 healthy — and diabetes-approved — snacks.

Q: Are there any serious side effects?

Canterbury:  Unfortunately, there can be. That’s why it’s important to be aware of what these serious side effects are, and call your doctor right away if you go through any of them. This can include changes in vision; back or stomach pain; frequent, painful or difficult urination; or cloudy, discolored or bloody urine. Same goes if you have nausea, vomiting, loss of appetite, flu-like symptoms, skin or eye yellowing, unusual bleeding or bruising, or a lack of energy.

Pioglitazone may also worsen symptoms of heart failure, like breathing problems, increased water retention and swelling of the feet. In addition, folks who take pioglitazone for more than a year may be more likely to get bladder cancer, according to the Food and Drug Administration. People who are on a high dose for a long time should be regularly monitored for signs of the disease.

This drug is also linked to liver failure. (You may need to get a liver test prior to taking pioglitazone.) Finally, it’s been shown to increase women’s chances of breaking a bone. Speak to your health care team to learn if you are at an elevated risk of any of these side effects.

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Q: Should certain people not take pioglitazone?

Canterbury:  If you’re pregnant, nursing or planning to become pregnant, pioglitazone is not generally recommended. (So if you are taking it for PCOS, you’ll need to stop as soon as you’re pregnant.) Also, due to the side effects listed above, make sure your doctor knows if you have a history of heart failure, liver problems, bladder cancer, blood in the urine, diabetes-related macular swelling, osteoporosis and/or osteopenia before considering pioglitazone.

Q: Are there any drug interactions that I need to know about?

Canterbury:  Yes. Tell your doctor and pharmacist about all the medications, vitamins and supplements you are taking before starting pioglitazone. And be sure to pay special attention to the ones below, as your doctor may want to adjust the amount of medication you take if you’re also on any of these:

Q: What’s the birth control interaction about?


Canterbury:  Taking pioglitazone when you’re on an oral contraceptive that contains estrogen and progesterone has been shown to reduce the blood concentrations of both hormones by about 30%. This doesn’t mean you can’t take birth control, but you should certainly talk about your options with your health care provider.

Q: Are there any food or drinks I need to stay away from while on pioglitazone?

Canterbury:  Yes. Limit your alcohol consumption, since it can lead to low blood sugar.

Help keep weight gain in check with these 21 healthy — and diabetes-approved — snacks.