Actos vs. Invokana for Diabetes Type 2: Important Differences and Potential Risks.

Key takeaways

Actos (pioglitazone) and Invokana (canagliflozin) are both oral prescription medications used to manage type 2 diabetes, but they work in different ways and belong to different drug classes. Actos helps your body use insulin more effectively, while Invokana helps your kidneys remove excess sugar through the urine. Actos is typically taken once daily with or without food. In contrast, Invokana is taken once daily before the first meal of the day and can also help reduce the risk of heart and kidney problems. Actos can cause weight gain and fluid build-up, which may worsen heart failure, while Invokana can lead to weight loss and raises the risk of genital infections and possibly amputations. Both medications can cause low blood sugar, especially when used with other diabetes treatments. Actos is available in generic form, whereas Invokana is only available as a brand-name medication.

Pioglitazone

(Actos)

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Invokana

(canagliflozin)

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Summary for Actos

Prescription only

Pioglitazone (Actos) is an oral medication used to treat Type 2 diabetes in adults, along with diet and exercise. It's a thiazolidinedione, which works by helping your body respond better to insulin. This medication is taken by mouth once a day and is available in both brand and generic forms. Side effects include headache, swelling in the body, and weight gain. There's also a serious warning that it can cause or worsen heart failure.

Indications for Actos

Type 2 diabetes in adults, along with diet and exercise

Pros and Cons for Actos

Pros

Only taken once a day
Rarely causes dangerously low blood sugar when taken by itself
Can be taken with or without food

Cons

Can cause fluid buildup in the body
Not safe for people with moderate to severe heart failure
Not a good choice for people with bladder cancer

Common Side Effects for Actos

Swelling (27%)
Upper respiratory tract infection (13%)
Headache (9%)
Heart failure (8%)
Sinus infection (6%)
Pain in the arms and legs (6%)

Side effects above are for pioglitazone (Actos) taken alone. These might differ if it's taken with other medications.

Warnings for Actos

Heart failure and swelling
Low blood sugar (when used with other medications)
Liver problems
Bladder cancer
Risk of bone fractures
Eye problems

Summary for Invokana

Prescription only

Invokana (canagliflozin) is a medication that's used together with a healthy diet and exercise to lower blood sugar levels in adults with Type 2 diabetes. It can also lessen the chance of worsening heart and kidney problems in some people with Type 2 diabetes. This medication is taken by mouth once a day.

Indications for Invokana

Type 2 diabetes
Lowering the risk of major heart events (e.g., heart attack, stroke) in adults with Type 2 diabetes and heart disease
Lowering the risk of hospitalization for heart failure, death due to heart problems, and worsening of kidney problems in certain adults with Type 2 diabetes and diabetic kidney disease

Pros and Cons for Invokana

Pros

Only taken once a day
Can use alone or together with other diabetes medications
Dose can be adjusted based on how well the medication is working for you

Cons

Only available as brand only
Might raise the risk of genital infections or bone fracture
Not recommended in second and third trimesters of pregnancy
Unknown if safe or works well in people on dialysis

Common Side Effects for Invokana

Vaginal yeast infection in females (11-12%)
Urinary tract infections (UTIs; 4-6%)
More urination (5%)

Warnings for Invokana

Leg and foot amputations
Ketoacidosis
Low fluids in the body (leading to low blood pressure or dehydration)
Genital and urinary tract infections
Low blood sugar (hypoglycemia) when used with certain other diabetes medications
Severe allergic reactions
Bone fractures