From the Guidelines
The most effective alternative to Actos (pioglitazone) is metformin, due to its high glucose-lowering efficacy, low risk of hypoglycemia, and neutral effect on weight, as well as its potential benefits on major adverse cardiovascular events (MACE) and heart failure (HF) 1. When considering alternatives to Actos, several factors must be taken into account, including the patient's kidney function, heart disease risk, weight management goals, and risk of hypoglycemia.
- Metformin is typically the first-line medication for type 2 diabetes due to its effectiveness, safety profile, and low cost, with a high glucose-lowering efficacy and no increased risk of hypoglycemia 1.
- Other alternatives include sulfonylureas, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors, and insulin, each with their own benefits and drawbacks, such as the risk of hypoglycemia, weight gain, and increased risk of heart failure 1.
- GLP-1 receptor agonists, such as semaglutide and dulaglutide, have been shown to have a high to very high glucose-lowering efficacy, with a low risk of hypoglycemia and potential benefits on MACE and renal endpoints 1.
- SGLT-2 inhibitors, such as empagliflozin and dapagliflozin, have an intermediate to high glucose-lowering efficacy, with a low risk of hypoglycemia and potential benefits on MACE, HF, and renal endpoints 1. The best alternative to Actos will depend on individual patient factors, and any medication change should be supervised by a healthcare provider who can determine the appropriate dosage and monitor for side effects or interactions with other medications 1.
From the Research
Alternatives to Actos
Actos, also known as pioglitazone, is a medication used to treat type 2 diabetes. Some alternatives to Actos include:
- Metformin: a biguanide that improves glycemic control by decreasing hepatic glucose output 2
- Sulfonylureas: stimulate insulin secretion and can be used in combination with thiazolidinediones like pioglitazone 3
- Exenatide: an incretin mimetic that can be used in combination with pioglitazone 4
- DPP-4 inhibitors: can be used in combination with pioglitazone to improve glycemic control 4
- Insulin: can be used in combination with pioglitazone to improve glycemic control 4
Mechanisms of Action
These alternatives have different mechanisms of action, including:
- Improving insulin sensitivity: pioglitazone and thiazolidinediones 4, 5
- Decreasing hepatic glucose output: metformin 2
- Stimulating insulin secretion: sulfonylureas 3
- Improving pancreatic beta-cell secretory function: pioglitazone 4
Benefits and Drawbacks
Each alternative has its own benefits and drawbacks, including:
- Pioglitazone: improves glycemic control, has anti-inflammatory and antioxidant effects, but can cause weight gain and fluid retention 4, 6
- Metformin: improves glycemic control, has a low risk of hypoglycemia, but can cause gastrointestinal side effects 2
- Sulfonylureas: stimulate insulin secretion, but can cause hypoglycemia and weight gain 3