What is Actos® (pioglitazone) and how does it work?
- Pioglitazone is a tablet that helps to regulate blood sugar levels in patients with Type 2 diabetes.
- Pioglitazone gained a license in the UK in 2000 and is marketed by Takeda UK Ltd.
Who needs pioglitazone?
- People with Type 2 diabetes often produce insulin but their bodies cannot respond to it properly (they have become resistant to the effects of their own insulin). This is different to people with Type 1 diabetes who don't produce enough insulin from an early age.
- In people with Type 2 diabetes, pioglitazone helps to control blood sugar levels.
- Pioglitazone has been found to improve certain blood lipid (or cholesterol) components in people with Type 2 diabetes.[1-3]. It is well known that high levels of cholesterol increase the risk of heart disease, an effect that is further accentuated in people with diabetes. 
How is pioglitazone used?
- Pioglitazone tablets can be taken on their own. This is usually the case in overweight people whose Type 2 diabetes has not been controlled by diet and exercise, and who cannot take metformin (another tablet used to treat diabetes). This could be because they have either kidney disease or because they have had intolerable side effects with metformin. 
- Pioglitazone tablets can also be taken with other tablets used to treat diabetes (e.g., metformin, sulphonylureas), when it has been seen that the other treatment has not controlled their diabetes. In this instance, pioglitazone can be taken with:
- metformin (particularly in overweight patients)
- a sulphonylurea (e.g., gliclazide), if patients are unable to receive metformin or have had side effects with metformin. 
Are there any side effects with pioglitazone?
- People taking pioglitazone tablets as their only treatment for diabetes may experience visual disturbances, upper respiratory chest infection, weight gain or decreased sensitivity to stimulation from light, pain or touch.
- Taking metformin and pioglitazone together may cause anaemia, visual disturbances, weight gain, headaches, aching joints, blood in the urine and erection problems.
- Taking a sulphonylurea and pioglitazone together may cause weight gain, dizziness and flatulence.
Can anyone take pioglitazone?
- People should not take pioglitazone if they have liver disease, current or past cardiac failure, or are taking insulin.
- Children, pregnant women and breastfeeding women should avoid taking pioglitazone.
Who prescribes pioglitazone and are people monitored while taking pioglitazone?
- Local GPs or hospital consultants can prescribe pioglitazone.
- There have been rare reports of reduced liver function with pioglitazone. Therefore, it is recommended that people have their liver function checked before treatment with pioglitazone, and then the prescribing doctor will decide how often the liver function needs to be monitored.
1. Charbonnel B, Schernthaner G, Brunetti P, Matthews DR, Urquhart R, Tan MH, Hanefeld M. Long-term efficacy and tolerability of add-on pioglitazone therapy to failing monotherapy compared with addition of gliclazide or metformin in patients with type 2 diabetes. Diabetologia 2005; 48: 1093-1104.
2. Tan MH, Johns D, Glazer NB. Pioglitazone reduces atherogenic index of plasma in patients with type 2 diabetes. Clin Chem 2004; 50: 1184-1188.
3. Goldberg RB, Kendall DM, Deeg MA, Buse J, Zagar AJ, Pinaire JA, Tan MH, Khan M, Perez AT, Jacober SJ, for the GLAI Study Investigators. A comparison of lipid and glycemic effects of pioglitazone and rosiglitazone in patients with type 2 diabetes and dyslipidaemia. Diabetes Care 2005; 28: 1547-1554.
4. Barnett AH, O'Gara G. Diabetes and The Heart. Churchill Livingstone, 2003.
5. Takeda UK Ltd. ACTOS Summary of Product Characteristics. September 2005.