Pioglitazone | Side Effects, Dosage, Uses & More
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Generic Name:

pioglitazone, Oral tablet

All Brands

  • Actos
SECTION 1 of 5

Highlights for pioglitazone

Oral tablet
1

Pioglitazone is an oral drug that’s used to decrease blood sugar caused by type 2 diabetes. It’s used along with diet and exercise.

2

Your dose depends on your blood sugar, other medications you’re taking, and other health conditions that you have.

3

You shouldn’t take this drug if you have type 1 diabetes or diabetic ketoacidosis. These conditions should be treated with insulin instead.

4

People with moderate to severe heart failure (defined as NYHA Class III or IV) or symptoms of heart failure shouldn’t take this drug. This drug can make heart failure worse.

5

Common side effects include cold-like symptoms (upper respiratory tract infection), such as headache, sinus congestion, muscle pain, and sore throat.

IMPORTANT INFORMATION

FDA warning

This drug has a Black Box Warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients to potentially dangerous effects.

Heart failure warning. This drug belongs to a class of drugs called thiazolidinediones. These drugs can cause or worsen heart failure. Symptoms of heart failure include:

  • fast weight gain
  • shortness of breath or trouble breathing, especially when you lie down
  • swelling or fluid retention in your arms or legs
  • unusual tiredness

Call your doctor right away if you have any signs of heart failure. Your doctor should monitor you carefully when starting this medication and when changing doses.

If you have signs of heart failure, you shouldn’t take this medication. Don’t take this drug if you have New York Heart Association (NYHA) Class III or IV heart failure.

Risk of becoming pregnant. This drug may cause you to ovulate (release of an egg from an ovary), which can lead to pregnancy. Ovulation may even occur in women who don’t have regular menstrual periods. Ask your doctor about effective forms of birth control to use while you’re taking this medication.

Not for type 1 diabetes

Don’t use this drug if you have type 1 diabetes or diabetic ketoacidosis. These conditions should be treated with insulin instead.

Eye problems warning

This drug may rarely cause swelling in the back of eyes (macular edema). This can lead to blurriness or changes in vision. Tell your doctor right away if you have any changes in your vision while taking this drug.

Bladder cancer warning

This drug may raise your risk of developing bladder cancer. You shouldn’t take this drug if you’re being treated for bladder cancer. Tell your doctor right away if you have any symptoms of bladder cancer, including:

  • blood or red-colored urine
  • an increased need to urinate
  • pain in your bladder when you urinate

What is piaglitazone?

This drug is a prescription drug. It’s available as an oral tablet.

This drug is available as a generic drug. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand.  Talk to your healthcare provider to see if the generic will work for you.

This drug may be used as part of a combination therapy. That means you need to take it with other drugs.

How it works

This drug belongs to a class of drugs called thiazolidinediones. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

This drug works by helping you respond better to the insulin that your body makes. It helps insulin take the sugar (glucose) from your bloodstream and move it into the cells, where it’s used to make fuel or energy. This lowers your blood sugar levels.

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SECTION 2 of 5

pioglitazone Side Effects

Oral tablet

More Common Side Effects

The more common side effects that occur with pioglitazone include:

  • cold-like symptoms (upper respiratory tract infection)

  • headache

  • sinus congestion

  • muscle pain

  • sore throat

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life-threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • severe low blood sugar (hypoglycemia). This can happen if you take pioglitazone with other diabetes drugs, such as sulfonylureas or insulin, which also lower blood sugar. Symptoms may include: 

    • mood changes, such as irritability, impatience, anger, stubbornness, or sadness
    • confusion, including delirium
    • lightheadedness or dizziness
    • sleepiness
    • blurred or impaired vision
    • tingling or numbness in your lips or tongue
    • headaches
    • weakness or fatigue
    • lack of coordination
    • nightmares or crying out during your sleep
    • seizures
    • loss of consciousness

    If you don’t treat low blood sugar, you can have a seizure, pass out, and possibly develop brain damage. Low blood sugar can even be fatal. If you pass out because of a low sugar reaction or cannot swallow, someone will have to give an injection of glucagon to treat the low sugar reaction. You may need to go to the emergency room.

  • eye problems. Pioglitazone may rarely cause swelling in the back of eyes (macular edema). Symptoms may include:

    • blurred vision
    • changes in your vision
  • bladder cancer. Symptoms may include:

    • blood or red-colored urine
    • an increased need to urinate
    • pain when you urinate
  • broken bones (fractures). These usually occur in the hand, upper arm, or foot, especially in women.

  • ovulation. This could increase your chance of becoming pregnant.

  • liver problems. Symptoms may include: 

    • nausea
    • vomiting
    • stomach pain
    • unusual or unexplained tiredness
    • loss of appetite
    • dark-colored urine
    • yellowing of your skin or the whites of your eyes
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug doesn’t cause drowsiness. However, it will decrease your blood sugar levels. This can cause your blood sugar level to drop too low (hypoglycemia). If you have a low blood sugar reaction, you need to treat it.

  • For mild hypoglycemia (55–70 mg/dL), treatment is 15–20 grams of glucose (a type of sugar). You need to eat or drink one of the following:
    • 3–4 glucose tablets
    • a tube of glucose gel
    • ½ cup of juice or regular, non-diet soda
    • 1 cup of nonfat or 1% cow’s milk
    • 1 tablespoon of sugar, honey, or corn syrup
    • 8–10 pieces of hard candy, such as lifesavers
  • Test your blood sugar 15 minutes after you treat the low sugar reaction. If your blood sugar is still low, then repeat the above treatment.

Once your blood sugar level is back in the normal range, eat a small snack if your next planned meal or snack is more than 1 hour later.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 5

pioglitazone May Interact with Other Medications

Oral tablet

Pioglitazone can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist. 

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol interaction

Limit how much alcohol you drink while taking pioglitazone. Alcohol can lower or raise your blood sugar levels.

Medications that might interact with this drug

Cholesterol drugs

Certain cholesterol drugs are known to slow down the action of a protein in your body that often helps break down drugs such as pioglitazone (cytochrome P450 2C8). When these drugs are taken with pioglitazone, the amount of pioglitazone in your body may become too high. These types of cholesterol drugs include: 

  • gemfibrozil

Antibiotics

Certain antibiotics are known to speed up the action of a protein in your body that often helps break down drugs such as pioglitazone (cytochrome P450 2C8). When these drugs are taken with pioglitazone, the amount of pioglitazone in your body may become too low. These antibiotics include:

  • rifampin

Other diabetes drugs

Taking pioglitazone with insulin or other drugs used to treat diabetes may cause severe low blood sugar. The dose of these medicines may need to be decreased if you take them with pioglitazone. 

  • insulin
  • sulfonylureas
    • glipizide
    • glimepiride
    • glyburide
  • meglitinides
    • nateglinide
    • repaglinide

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
heart failure
People with heart failure and swelling (edema)

This drug can cause your body to retain extra fluid. This leads to swelling and weight gain and may worsen your heart problems or lead to heart failure. Don’t take this drug if you have severe heart failure. Your doctor will monitor you for signs of heart failure while you take this drug.

liver disease
People with liver disease

This drug may cause liver failure. Use this drug with caution if you have liver disease.

bladder cancer
People with bladder cancer

Don’t take this medication if you’re receiving treatment for bladder cancer. This drug may make your condition worse.

diabetic eye disease
People with diabetic eye disease

If you have swelling in the back of the eye (macular edema), you shouldn’t take this drug. This drug may make your condition worse.

bone fractures
People with bone fractures

This medication may raise your risk for more fractures. Use this medication with caution, especially if you’re a female.

pregnant women
Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

breastfeeding
Women who are breast-feeding

It isn’t known if this drug passes through breast milk. If it does, it may cause serious effects in a breast-feeding child.

You and your doctor may need to decide if you’ll take this drug or breast-feed.

for seniors
For seniors

As you age, your organs (such as your kidneys and liver) may not work as well as they did when you were younger. This may make you more sensitive to the effects of this medication. It may also be harder for you to recognize the symptoms of low blood sugar (hypoglycemia).

Your doctor may give you a lower dose of this drug to avoid serious side effects, such as low blood sugar. They may also monitor you more closely.

for children
For children

The safety and effectiveness of this drug in children younger than 18 years haven’t been established.

Keep this drug and all medicines out of the reach of children.

call doctor
When to call the doctor
  • Call your doctor if you get sick or injured, have an infection, or plan to have surgery. This drug may not control your blood sugar levels during these times. Your doctor may stop this drug for a short time and give you insulin to control your blood sugar.
  • Let your doctor know if you become pregnant or plan to become pregnant. Your doctor may stop treatment with this drug and change your diabetes treatment plan.
allergies
Allergies

This drug can cause a severe allergic reaction. Symptoms may include:

  • trouble breathing
  • swelling of your throat or tongue
  • hives

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal.

SECTION 4 of 5

How to Take pioglitazone (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on: 

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Type 2 diabetes

Generic: pioglitazone

Form: Oral tablet
Strengths: 15 mg, 30 mg, 45 mg

Brand: Actos

Form: Oral tablet
Strengths: 15 mg, 30 mg, 45 mg
Adult dosage (ages 18–64 years)
  • The recommended starting dose is 15 mg or 30 mg taken by mouth once per day with or without meals.
  • Your doctor may increase or decrease your dose based on your blood sugar levels. The maximum dose is 45 mg taken once per day.
Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in people younger than 18 years.

Senior dosage (ages 65 years and older)

As you age, your organs (such as your kidneys and liver) may not work as well as they did when you were younger. This may make you more sensitive to the effects of this medication. It may also be harder for you to recognize the symptoms of low blood sugar (hypoglycemia).

Your doctor may give you a lower dose of this drug to avoid serious side effects, such as low blood sugar. They may also monitor you more closely.

Special considerations

Heart failure:

  • The recommended starting dose for people with congestive heart failure (defined as NYHA Class I or II) is 15 mg taken once per day.
  • Your doctor should monitor you carefully when starting this medication and when changing doses.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug comes with serious risks if you don't take it as prescribed.

If you don't take it at all

You may still have high blood sugar levels. Over time, elevated blood sugar levels can harm your eyes, kidneys, nerves, or heart. Severe issues include heart attack, stroke, blindness, kidney failure and dialysis, and limb amputations.

If you take too much

If you take too much of this drug, you may have low blood sugar (hypoglycemia). Symptoms may include:

  • shakiness
  • nervousness or anxiety
  • sweating, chills, and clamminess
  • irritability or impatience
  • confusion, including delirium
  • fast heart rate
  • lightheadedness or dizziness
  • hunger and nausea
  • sleepiness
  • blurred or impaired vision
  • tingling or numbness in your lips or tongue
  • headaches
  • weakness or fatigue
  • anger, stubbornness, or sadness
  • lack of coordination
  • nightmares or crying out during your sleep
  • seizures
  • loss of consciousness

If you think that you’ve taken too much of this medication or have symptoms of low blood sugar, treat your low blood sugar.

Seek emergency help right away if you have symptoms of severe low blood sugar, such as loss of consciousness, seizures, coma, and neurological problems.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours before the time for your next dose, then only take one dose at that time.

Never try to catch up by taking two doses at once. This could cause toxic side effects.

How to tell if the drug is working

If this drug is working, your symptoms of high blood sugar should decrease. You may not urinate as often or be as thirsty or hungry.

This drug is used for long-term treatment.

Store this drug at room temperature

  • Keep it from 59°F (15°C) to 86°F (30°C).
  • Keep this drug in its original container to protect it from light.
  • Keep the bottle closed tightly and keep tablets dry.
  • Keep the drug away from high temperature.
  • Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

A prescription for this medication is refillable

You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you or in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t hurt this medication.
  • You may need to show airport staff your pharmacy’s label to clearly identify the medication. Keep the original prescription label with you when traveling.
  • Don’t leave this medicine in the car, especially when the temperature is hot or freezing.
  • Lancets need to be used to test your blood sugar. Check for special rules about traveling with lancets.

Self-management

You’ll need to test your blood sugar level at home using a blood glucose monitor. Your doctor may adjust your dose of this drug based on your blood sugar levels.

You’ll need to learn how to do the following:

  • use a blood glucose monitor to test your blood sugar regularly at home
  • recognize the signs and symptoms of high and low blood sugar
  • be able to treat low and high blood sugar reactions

While taking this drug, you’ll need to regularly test your blood sugar levels. You may need to purchase the following:

  • sterile alcohol wipes
  • lancing device and lancets (a pricking needle used to prick your finger to draw a drop of blood for testing blood sugar)
  • blood sugar test strips
  • blood glucose monitor
  • needle container for safe disposal of lancets

Clinical monitoring

Before starting and while taking this drug, your doctor may check your:

  • blood sugar levels
  • glycosylated hemoglobin (A1C) levels. This test measures your blood sugar control over the last 2–3 months.
  • liver function. If your liver tests are abnormal, or if you have symptoms of liver damage, your doctor may decide to stop this medication.

Your diet

Managing type 2 diabetes well includes eating a healthy diet.

You should talk to your doctor about how to change your eating habits. In general, a healthy diet is made up of fruits, vegetables, whole grains, fiber-rich foods, fish, and good fats, such as avocados, almonds, and olives.

Hidden costs

In addition to this medicine, you may need to purchase the following:

  • sterile alcohol wipes
  • lancing device and lancets (to prick your finger to test your blood sugar)
  • blood sugar test strips
  • blood glucose monitor
  • needle container for safe disposal of lancets

Insurance

Many insurance companies will require a prior authorization before they approve the prescription and pay for this drug.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

SECTION 5 of 5

How Much Does pioglitazone Cost?

Oral tablet

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These prices represent the lowest priced national pharmacies for pioglitazone on GoodRx. They may be lower than your insurance.

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Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 18, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
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