ACTOS (Pioglitizone) is a medication for Type 2 Diabetes that works by making your own insulin work more effectively in muscle, fat, and liver tissues.   It is a very effective and tolerable medication, but there are some controversies.

It has been available for over a decade and is now going generic.  Since this medication is very pricey, a generic alternative is a great savings.

Recently, a patient told me that his pharmacist said ACTOS would be taken off the market due to dangerous side effects…..but this is not the case.  There have been some issues with this class of medication and with ACTOS in particular, but none have been severe enough to warrant removal of this medication from use.  The controversies and issues are:
1.  Liver inflammation–This has rarely been a concern.  Simple blood test monitoring when you begin the medication can monitor this issue.

2.  Heart Failure–Another medication in this class, AVANDIA, has been known to cause issues with fluid retention in patients with congestive heart failure and is not to be used in such patients.  ACTOS has not been criticized as much as AVANDIA, for this issue, but it is still a consideration with ACTOS and if you have heart failure, ACTOS is not advisable.

3.  Bladder Cancer–Recent studies show a potential increased risk of bladder cancer in patients specifically on ACTOS.  In fact, I have seen advertisements on TV, from lawyer groups, looking for patients who want to sue the drug manufacturer if they have bladder cancer and are on ACTOS.  Whether this association is enough to warrant more caution in the future, it is unknown and the issue is under further investigation.  At this time, ACTOS has a warning noted on it’s package warnings about this potential, but the severity of the association will need further data.

Controlling blood sugar is critical for the health of diabetic patients and ACTOS can be an effective medication in assisting in treatment.  There are consequences of poor sugar control, just as there are side effects from medications.   The balance of pro’s and con’s need to be considered for each individual patient in deciding on the need and use of ACTOS….but for now, as Mark Twain said about his premature obituary:  “The reports of my death are greatly exagerated!”

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