How Does Actos Work to Manage Type 2 Diabetes?

If you’ve been diagnosed with Type 2 diabetes, healthy lifestyle changes are usually the first step. But sometimes medications are added to help get your blood sugar under control. And there are quite a few types of medication to choose from. 

Actos is one medication used for Type 2 diabetes. Your healthcare provider may talk to you about taking Actos to help manage your blood sugar. But what is the mechanism of Actos inside your body? And how does it work to treat diabetes?

What is Actos (pioglitazone)?

Actos is an oral medication used to treat Type 2 diabetes. It comes in 15 mg, 30 mg, and 45 mg tablets. A typical dosage is either 15 mg or 30 mg once daily by mouth. The 45 mg dose is more likely to cause side effects.

Promotion disclosure

Actos (Pioglitazone)

Avg retail price

$179.88(Save 93.42%)

GoodRx discount

$11.84

See all discounts

How it works

Use GoodRx to find medications, pharmacies, and discounts.

GoodRx discounts can help you pay less for your prescription.

Bring your free coupon or savings card to the pharmacy.

Actos is prescribed both on its own and in combination with another diabetes medication — like metformin or insulin.

What drug class does Actos belong to?

Actos belongs to a class of medications called thiazolidinediones. This can be a mouthful to say –– luckily, they’re also referred to as “glitazones” or “TZDs.” 

Another medication in this class is Avandia (rosiglitazone). But Avandia can cause heart problems — so it’s not prescribed often in the U.S. Actos has a lower risk of causing heart problems, so it’s the preferred medication in this class.

How do Actos and other glitazones work in the body?

Management of Type 2 diabetes is constantly evolving. Each medication class tackles the condition from a different angle. But they all have a similar end-goal — lowering blood sugar. And they should all be taken in combination with a healthy diet and regular exercise.

Type 2 diabetes develops when one of two things happen: either the body isn’t responding well to insulin (also called insulin resistance) or it’s not making enough insulin. Insulin is the key to unlocking how well your body uses sugar as energy. If you don’t have a good response to insulin, your body cannot properly use sugar as fuel. Instead, the sugar hangs around in the blood. Over time, this can cause damage to your body. 

What is the mechanism of Actos?

Actos has a complex mechanism of action. But it all starts when Actos activates a receptor (chemical binding site) in your fat, muscle, and liver tissues. When activated, this receptor helps control the production of hormones and enzymes that stop the body from using insulin properly. In essence, it “cleans up” things in the body that block insulin from working. 

This “clean up” process has four main effects:

1. Increased insulin sensitivity: Actos helps your body respond to insulin better — especially if you already have insulin resistance. 

2. Lower blood sugar: The increased insulin sensitivity helps your muscle cells use more sugar from the blood as fuel. This helps decrease the amount of sugar in your bloodstream.

3. Less glucose production: They also slow down how much glucose your liver makes. This also lowers the amount of sugar circulating in your blood.

4. Keeps ß-cells in the pancreas working: The ß-cells of the pancreas produce insulin. In some people with Type 2 diabetes, they stop working over time. Actos helps protect these cells to keep them working, which helps prevent diabetes from getting worse. 

The combination of these effects stops excess sugar from hanging around and damaging your organs. 

The measure of how well your body is managing blood sugar over time is called the hemoglobin A1C level. Actos and other glitazones lower A1C levels by around 1% in clinical studies. Your provider will discuss your A1C goals with you and how Actos may be able to help you reach them.

How long does it take for Actos to start working?

As mentioned, Actos and other glitazones affect certain genes to increase your insulin sensitivity. That process takes time –– possibly several weeks — to take effect. 

The full effect of the medication can take anywhere from 6 weeks to 6 months, which is relatively longer than most other diabetes medications. It’s important to be patient while taking this medication and continue to take it as directed, even if your blood sugar levels don't improve right away. 

How is Actos different from other Type 2 diabetes medications, like metformin?

Actos vs. metformin

Actos is different from other medications for Type 2 diabetes because it’s the only one that affects the genes inside your cells. Another medication, metformin, also slows down how much sugar your liver makes and improves how well your body responds to insulin. But it doesn’t activate the same receptor that Actos does. What’s more, metformin can cause some people to lose weight, while Actos can cause weight gain. 

Actos and metformin are also available in a single pill that contains both medications — pioglitazone/metformin (Actoplus Met). 

Actos vs. sulfonylureas and gliptins

Other medications, like glimepiride (Amaryl), glipizide (Glucotrol), and repaglinide (Prandin), work very differently. They directly help your body release more insulin. Gliptin medications, like sitagliptin (Januvia) and linagliptin (Tradjenta), help your body release more insulin too, but in a more indirect way. Sometimes, these medications will be used along with Actos, because they help the body release enough insulin for Actos to work. 

Side effects of Actos vs. other diabetes medications

• Hypoglycemia. Some diabetes medications can cause blood sugar levels to drop too low (hypoglycemia). This can be a difficult side effect to manage and can be dangerous in some settings. Actos doesn’t usually cause this side effect when used alone, since it doesn’t have a direct effect on insulin levels. But if Actos is added to another diabetes medication, it can make hypoglycemia more likely.

• Heart failure. Actos can cause your body to retain fluid. This can lead to a dangerous complication known as congestive heart failure. Other medications for diabetes don’t have this serious side effect (although they may have others to be aware of). This side effect is one of the reasons TZDs have a boxed warning and should be avoided in certain people with heart failure.

What medications should not be taken with thiazolidinediones like Actos?

TZDs like Actos are generally safe to take in combination with other diabetes medications, like metformin or insulin. In fact, there are several medications that combine Actos with another diabetes medication in one pill — like pioglitazone/glimepiride (Duetact). 

As mentioned above, adding Actos to another medication may result in hypoglycemia. If you experience sweating, chills, or dizziness when taking Actos, be sure to consume a fast-acting sugar as soon as possible. It’s important to carry glucose tablets or gel with you — they can be a literal life-saver. If you experience low blood sugar symptoms often, contact your healthcare provider. Your medications may need to be adjusted. 

There are also interactions with non-diabetes medications to keep in mind. For example, medications like gemfibrozil (Lopid) and clopidogrel (Plavix) can boost the effects of Actos. It’s recommended to limit your Actos dose to 15 mg a day if you’re taking one of these medications. 

This is not a complete list of all drug interactions. Be sure to discuss your entire medication list with your healthcare provider before starting Actos. They can help catch any potential issues.

How to save on your Actos prescription

Actos is available as both a brand-name and generic medication. GoodRx can help you save almost 80% off the average retail price of the generic version. The generic pioglitazone price at certain pharmacies is less than $15 with a free GoodRx discount. Depending on your insurance, you may also be able to save by filing a 90-day supply of Actos. 

Why trust our experts?

Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

Our editorial standards

Meet our experts