How is Actos (pioglitazone) usually dosed?

Dosing of Actos (Pioglitazone)

Actos (pioglitazone) is typically dosed at 15 mg, 30 mg, or 45 mg once daily, with 15 mg being the recommended starting dose and 45 mg being the maximum approved daily dose. 1, 2

Standard Dosing Regimen

• Starting dose: 15 mg once daily
• Maintenance dose: 15-45 mg once daily
• Maximum approved dose: 45 mg once daily

The dose can be titrated based on glycemic response, typically after 8-12 weeks of treatment if adequate glycemic control is not achieved.

Administration Considerations

• Can be taken with or without food 3
• May be taken as a single daily dose at bedtime or with the main meal to minimize gastrointestinal effects 3
• No data supports intermittent dosing; should be taken daily

Special Populations

• Patients with CKD: Lower doses (7.5-15 mg) may be effective with fewer side effects in patients with chronic kidney disease 4
• Elderly patients: Consider starting at the lower end of the dosing range (15 mg) due to increased risk of fluid retention and heart failure

Efficacy at Different Doses

The efficacy of pioglitazone is dose-dependent:

• 15 mg: Provides moderate glycemic control
• 30 mg: Intermediate efficacy
• 45 mg: Maximum efficacy with HbA1c reductions of approximately 0.9-1.6% compared to placebo 1

Side Effects and Monitoring

Side effects are often dose-dependent:

• Weight gain: 0.9-2.6 kg at doses of 15-45 mg daily 2
• Edema/fluid retention: More common at higher doses, particularly when combined with insulin 2
• Heart failure risk: Increases with dose, particularly in patients with cardiovascular disease

Combination Therapy Considerations

When used in combination therapy:

• With sulfonylureas: 15-30 mg daily
• With metformin: 15-30 mg daily
• With insulin: 15-30 mg daily (note: may cause more significant weight gain and fluid retention) 2

Common Pitfalls to Avoid

1. Starting at too high a dose: This increases risk of edema and weight gain
2. Failure to monitor for fluid retention: Watch for early signs of edema, especially when initiating therapy
3. Overlooking heart failure risk: Avoid in patients with NYHA Class III or IV heart failure
4. Not considering lower doses in CKD: Lower doses (7.5-15 mg) may be equally effective with fewer side effects in CKD patients 4

In summary, pioglitazone dosing should start at 15 mg once daily and can be titrated up to 45 mg once daily based on glycemic response and tolerability, with careful monitoring for weight gain and fluid retention.