Actos (pioglitazone) is a prescription drug that’s used to treat type 2 diabetes. This drug can interact with other medications and some supplements. For example, Actos can interact with certain other medications that treat diabetes.
Actos is used to manage blood sugar levels in adults with type 2 diabetes.
An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.
Keep reading to learn about Actos’s possible interactions. And for more information about Actos, including details about its uses, see this article.
Before you start taking Actos, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Actos interacts with herbs or vitamins and supplements, see the “Are there other interactions with Actos?” section.)
If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.
The table below lists drugs that may interact with Actos. Keep in mind that this table does not include all drugs that may interact with Actos. For more information about some of these interactions, see the “Drug interactions explained” section.
| Drug group or drug name | Drug examples | What can happen |
|---|---|---|
| angiotensin converting enzyme (ACE) inhibitors | • lisinopril (Zestril, Qbrelis) • benazepril (Lotensin) | can increase the effect of and the risk of side effects from Actos |
| angiotensin II receptor blockers (ARBs) | • valsartan (Diovan) • olmesartan (Benicar) | can increase the effect of and the risk of side effects from Actos |
| corticosteroids | • dexamethasone (Hemady) • prednisone (Rayos) | can make Actos less effective |
| certain antidiabetic medications | • insulins, such as insulin degludec (Tresiba) • sulfonylureas, such as glipizide (Glucotrol XL) | can increase the risk of low blood sugar as a side effect of Actos and other diabetes medications |
| certain antipsychotic medications | • ziprasidone (Geodon) • olanzapine (Zyprexa) | can make Actos less effective |
| atorvastatin (Lipitor) | — | can make atorvastatin or Actos less effective |
| digoxin (Lanoxin) | — | can increase the effect of and the risk of side effects from digoxin |
| gemfibrozil (Lopid) | — | can increase the effect of and the risk of side effects from Actos |
| rifampin (Rimactane) | — | can make Actos less effective |
| topiramate (Topamax) | — | can make Actos less effective |
Certain health conditions or other factors could raise your risk of harm if you take Actos. In such cases, your doctor may not prescribe Actos for you. These are known as contraindications. The list below includes contraindications of Actos.
If you have class 3 or 4 heart failure: Actos has a boxed warning about the risk of new or worsening heart failure. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). Because of this risk, doctors typically won’t prescribe Actos if you have class 3 or 4 heart failure. To learn more about this warning, see the beginning of this article. You can also talk with your doctor or pharmacist to learn more.
If you’ve had an allergic reaction: If you’ve had an allergic reaction to Actos or any of its ingredients, your doctor likely won’t prescribe Actos for you. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.
Before you start taking Actos, talk with your doctor if any of the factors above apply to you. Your doctor can determine whether Actos is safe for you to take.
Your doctor may suggest avoiding or limiting alcohol consumption if you have diabetes, including if you’re prescribed Actos. (Actos is prescribed to treat type 2 diabetes.)
Alcohol doesn’t directly interact with Actos. But alcohol can lower your blood sugar and raise your risk for hypoglycemia (low blood sugar). Actos also lowers your blood sugar and can cause hypoglycemia as a side effect.
If you have questions about consuming alcohol while taking Actos, talk with your doctor or pharmacist.
Learn more about certain drug interactions that can occur with Actos.
Interaction with certain antidiabetic medications
Actos can interact with certain antidiabetic medications, which are used to treat diabetes. Actos and sulfonylureas are prescribed to treat type 2 diabetes. Insulins may be prescribed to treat either type 1 or type 2 diabetes.
Examples of antidiabetic medications that can interact with Actos include:
- insulins, such as:
- insulin degludec (Tresiba)
- insulin aspart (Novolog, Fiasp)
- sulfonylureas, such as:
- glipizide (Glucotrol XL)
- glimepiride (Amaryl)
What could happen
Actos and insulins or sulfonylureas can both cause hypoglycemia (low blood sugar) when used on their own. Sulfonylureas and insulins typically come with a higher risk of hypoglycemia than other medications that treat diabetes. So, taking these drugs together can raise your risk of this side effect.
What you can do
If you take Actos with a sulfonylurea or insulin, your doctor may prescribe a dosage of Actos, insulin, or a sulfonylurea that’s lower than usual. You should not take a higher dose of either medication than your doctor prescribes.
If you have questions about taking Actos with insulins or sulfonylureas, talk with your doctor or pharmacist.
Interaction with gemfibrozil
Actos can interact with gemfibrozil, which is used to treat high cholesterol and high triglycerides.
What could happen
Gemfibrozil slows the activity of CYP2C8, which is an enzyme your body uses to break down Actos. (“CYP2C8” stands for “cytochrome p450 2C8.”) If CYP2C8 activity is slowed, the level of Actos in your system can increase to high levels. This raises your risk for side effects of Actos, including hypoglycemia.
What you can do
If you’re prescribed both gemfibrozil and Actos, your doctor will likely prescribe a lower Actos dose for you. When used with gemfibrozil, the recommended maximum daily dose of Actos is 15 milligrams.
Interaction with ACE inhibitors
Actos can interact with ACE inhibitors, which are used to treat high blood pressure. They’re also prescribed for people with heart failure and for people with type 2 diabetes to lower certain risks.
Examples of ACE inhibitor medications include:
- lisinopril (Zestril, Qbrelis)
- benazepril (Lotensin)
- ramipril (Altace)
What could happen
ACE inhibitors can enhance the effect of Actos, which works by lowering your blood sugar. Using an ACE inhibitor with Actos can raise your risk for hypoglycemia as a side effect.
What you can do
This interaction is not considered severe. It’s typically safe to take Actos with an ACE inhibitor. (In fact, this combination is not unusual.) In this situation, your doctor will likely closely monitor your blood sugar level. If you develop hypoglycemia during treatment, they may prescribe a lower Actos dosage or lower your ACE inhibitor dosage.
Actos may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that this information does not include all other possible interactions with Actos.
Does Actos interact with supplements?
Before you start taking Actos, talk with your doctor and pharmacist about any herbs or vitamins and supplements you take. Sharing this information with them may help you avoid possible interactions.
If you have questions about interactions that may affect you, talk with your doctor or pharmacist.
Actos interactions with herbs
Actos can interact with garlic supplements, which are used to boost immunity, among other uses.
Both Actos and garlic supplements can lower your blood sugar level. This can raise your risk for hypoglycemia (low blood sugar). Because of this risk, your doctor may recommend avoiding garlic supplements while you’re taking Actos.
Note: Actos isn’t expected to interact with garlic found in or used to season food. Garlic supplements contain a much larger amount of garlic than is used to season food.
Actos interactions with vitamins or minerals
Actos can interact with chromium supplements. Chromium is a mineral that some people take as a supplement to help manage their blood sugar levels.
Both Actos and chromium can lower your blood sugar level. This can raise your risk for hypoglycemia. Because of this risk, your doctor may recommend avoiding chromium supplements while you’re taking Actos.
Actos can also interact with niacin (vitamin B3) supplements. Niacin is also found in certain foods, but there is no expected interaction between Actos and foods containing niacin. Niacin supplements, on the other hand, contain a much larger amount of niacin than is found in food. And niacin can make Actos less effective because it can cause an increase in blood sugar levels.
Keep in mind that some multivitamins may contain chromium and niacin. Talk with your doctor or pharmacist if you need help determining whether your multivitamin contains chromium or niacin. They can also help you find the right multivitamin for you.
Does Actos interact with food?
Actos may interact with green tea and green tea supplements. Green tea can lower your blood sugar, and Actos works by lowering your blood sugar levels. Consuming green tea or taking green tea supplements can raise your risk for hypoglycemia.
Due to this risk, your doctor may advise avoiding green tea supplements while you’re taking Actos. It may be OK to consume green tea as a drink while taking Actos, but talk with your doctor first. They can discuss your risk for hypoglycemia and ways to lower it. They can also help you understand what to do if you have symptoms of hypoglycemia.
Does Actos interact with vaccines?
There are currently no reports of Actos interacting with vaccines. If you have questions about getting certain vaccines during your Actos treatment, talk with your doctor.
Does Actos interact with lab tests?
There are currently no reports of Actos interacting with lab tests. If you have questions about having certain lab tests during your treatment with Actos, talk with the healthcare professional ordering the test.
Does Actos interact with cannabis or CBD?Cannabis(commonly called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Actos. CBD, including CBD found in cannabis, can slow your body’s ability to break down Actos. This can increase the level of Actos in your system, raising your risk for side effects.
Before you start treatment with Actos, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.
Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.
Certain medical conditions or other health factors may raise the risk of interactions with Actos. Before taking Actos, talk with your doctor about your health history. They’ll determine whether Actos is right for you.
Health conditions or other factors that might interact with Actos include:
Heart failure: To learn more, see the “Boxed warning” section in the intro of this article.
Liver conditions, such as liver failure: Rarely, liver damage and liver failure have been reported as side effects of Actos. If you have an existing liver condition, taking Actos could worsen it.
Diabetic eye disease (diabetic retinopathy) or macular edema: There have been reports of macular edema in people taking Actos. People with diabetic retinopathy are at increased risk of developing macular edema, and taking Actos could further raise this risk. If you have macular edema, there’s a chance that taking Actos could worsen your condition.
Past or current bladder cancer: Some studies show a small but increased risk for bladder cancer in people taking Actos. But other studies have not shown this risk. Currently, it’s not known for certain whether taking Actos raises the risk of developing bladder cancer. But to be safe, doctors typically won’t prescribe Actos if you currently have or have had bladder cancer. Instead, they can recommend other diabetes treatments that are safer for you.
Type 1 diabetes: Actos should not be used to treat type 1 diabetes. The drug is approved only for treating type 2 diabetes. If you have type 1 diabetes, your doctor can suggest treatments that are approved for that condition.
Osteoporosis: Taking Actos can increase the risk of bone fractures in women. If you have osteoporosis, taking Actos may raise your risk of bone fractures. Talk with your doctor about whether Actos is safe for you to take.
Pregnancy: It’s not known whether Actos is safe to take during pregnancy. If you’re pregnant or planning a pregnancy, talk with your doctor before taking Actos.
Breastfeeding: It’s not known whether it’s safe to take Actos while breastfeeding. It isn’t known whether the drug passes into breast milk or whether the drug may cause side effects in a child who is breastfed. If you’re breastfeeding or planning to breastfeed, talk with your doctor about your options.
Allergic reaction: If you’ve had an allergic reaction to Actos or any of its ingredients, your doctor will likely not prescribe Actos. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.
Taking certain steps can help you avoid interactions with Actos. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:
- whether you drink alcohol or use cannabis
- other medications you take, as well as any vitamins, supplements, and herbs (they can also help you fill out a
medication list ) - what to do if you start taking a new drug during your Actos treatment
It’s also important to understand Actos’s
If you have trouble reading or understanding this information, your doctor or pharmacist can help.
Taking Actos exactly as prescribed can also help prevent interactions.
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 another 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.