Is Actos Safe?

Still, pioglitazone works so well in older patients that, in my judgment, the benefits outweigh the possible risks for most people. For the reasons mentioned above, if you take pioglitazone, you and your doctor or other health professional should carefully watch for signs or symptoms of heart failure. These include shortness of breath (dyspnea) when you exert yourself or when you lie down, sudden weight gain, or swelling in your legs, ankles and feet. This is especially important when you start taking the drug and whenever there is a change in dosage. Your physician or other health professional should see you on at least a monthly basis until your optimal dose is reached, and after that evaluate your hemoglobin A1c and physical condition at 90-day intervals.

Patients who take pioglitazone also should do a couple of simple self-checks every day. The first is to press a finger into one of their ankles and make sure that there's no indentation left behind when they lift it. If the indentation remains, it's a sign of edema. The second is to make sure they're able to breathe freely when lying down without having to use a pillow to elevate their head. If they should experience trouble breathing, they should get to an emergency room right away.

Fnally, it's important to remember that older patients do not need to keep their blood glucose levels quite as low as younger patients need to. While the American Geriatrics Society recommends that "a reasonable goal for A1c in relatively healthy adults with good functional status is 7 percent or lower," I find that an appropriate target for older people is 7 or to 9 percent.

Although metformin — either alone or with glipizide or glimepiride — is often cited as the treatment of choice for people with type 2 diabetes, it's nearly always the wrong treatment for older patients, who typically lack the ability to flush the drugs out of their kidneys before they accumulate at toxic levels. Because pioglitazone is metabolized in the liver, not the kidneys, it's typically the best way to control type 2 diabetes in older patients.

Ask the Pharmacist is written by Armon B. Neel Jr., PharmD, CGP, in collaboration with journalist Bill Hogan. They are coauthors of Are Your Prescriptions Killing You?, which was published in July by Atria Books.