Is Pioglitazone (Actos) safe for inpatients?

From the Guidelines

Actos is not recommended for use in the inpatient setting due to the potential risk of precipitating or worsening heart failure and peripheral edema. The use of thiazolidinediones, such as Actos, in hospitalized patients is not advised because of these potential limitations 1. In the management of inpatient hyperglycemia and diabetes, noninsulin antihyperglycemic agents, including Actos, are not recommended due to their slow onset of action and potential risks 1.

Some key points to consider when evaluating the use of Actos in the inpatient setting include:

• The risk of heart failure and peripheral edema associated with thiazolidinediones 1
• The slow onset of action of noninsulin antihyperglycemic agents, which may not allow for rapid dose adjustment to meet the changing needs of the acutely ill patient 1
• The potential for hypoglycemia with insulin secretagogues 1
• The need for careful monitoring and consideration of specific contraindications, such as active heart failure, liver disease, or high risk for fractures

In contrast to Actos, other medications, such as incretin-based therapies, have been shown to be safe and effective in the hospital setting, with few side effects and lower rates of hypoglycemia compared to insulin regimens 1. Therefore, alternative treatments, such as incretin-based therapies, may be preferred for the management of hyperglycemia in hospitalized patients.

From the FDA Drug Label

ACTOS should be used with caution in patients with edema. In all U. S. clinical trials, edema was reported more frequently in patients treated with ACTOS than in placebo-treated patients and appears to be dose related ACTOS is not indicated in patients with NYHA Class III or IV cardiac status Patients with NYHA Class III and IV cardiac status were not studied in these ACTOS clinical trials. In postmarketing experience with ACTOS, cases of congestive heart failure have been reported in patients both with and without previously known heart disease.

• Safety in inpatient setting: The FDA drug label does not provide direct information on the safety of Actos in an inpatient setting.
• Key considerations:
  • The drug should be used with caution in patients with edema or at risk for heart failure.
  • It is not indicated in patients with NYHA Class III or IV cardiac status.
  • Patients should be monitored for signs and symptoms of heart failure.
  • The label does not provide specific guidance on inpatient use, and caution should be exercised when using Actos in this setting 2.

From the Research

Safety of Actos (Pioglitazone) in Inpatient Settings

• The safety of Actos (pioglitazone) in inpatient settings is a concern due to its potential side effects, such as fluid retention and heart failure 3.
• Pioglitazone is contraindicated in patients with heart failure, and its use should be avoided in patients with a history of heart failure or those at risk of developing heart failure 3.
• However, pioglitazone has been shown to have beneficial effects on glycemic control, insulin resistance, and cardiovascular risk factors in patients with type 2 diabetes 4, 5.
• In terms of safety, pioglitazone has been associated with an increased risk of fractures, weight gain, and fluid retention, but these risks can be mitigated with proper patient selection and monitoring 4, 5.
• A network meta-analysis of dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose co-transporter-2 inhibitors found that pioglitazone was not included in the analysis due to its contraindication in heart failure patients 6.
• An older study reviewed the pharmacology, clinical trial evidence, side-effects, and current clinical uses of pioglitazone, highlighting its potential as a new treatment for type 2 diabetes 7.