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Farxiga vs Actos
Introduction
For patients with type 2 diabetes, certain drugs that influence the body's ability to manage blood glucose levels can help in stabilizing these levels and managing symptoms. Farxiga and Actos are two such drugs that are prescribed for this purpose. They each impact different aspects of glucose metabolism but both have effects in maintaining normal blood sugar levels in patients with diabetes. Farxiga is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which works by preventing the kidneys from reabsorbing glucose back into the blood, thereby promoting its excretion through urine. Actos, on the other hand, belongs to a class of medications called thiazolidinediones; it improves insulin sensitivity in muscle and fat cells while also inhibiting liver gluconeogenesis - essentially reducing excessive liver production of glucose.
Farxiga vs Actos Side By Side
| Attribute | Farxiga | Actos |
|---|---|---|
| Brand Name | Farxiga | Actos |
| Contraindications | Patients with a history of bladder cancer or undergoing treatment for bladder cancer, patients prone to urinary tract infections or genital yeast infections | Patients with a history of bladder cancer or undergoing treatment for bladder cancer, patients with liver disease |
| Cost | Around $610 for 30 tablets of 10 mg | About $470 for 30 tablets of 15 mg |
| Generic Name | Dapagliflozin | Pioglitazone |
| Most Serious Side Effect | Dehydration symptoms such as severe dizziness, fainting, or light-headedness; signs of a serious allergic reaction | Signs of bladder cancer, heart failure, unexpected fractures in women |
| Severe Drug Interactions | Diuretics (water pills) due to increased risk of dehydration and low blood pressure | Not specifically mentioned, but caution is advised due to potential for fluid retention and exacerbation of heart failure |
| Typical Dose | 5-10 mg/day | 15-30 mg per day, up to a maximum of 45 mg per day |
What is Farxiga?
Dapagliflozin (the generic name for Farxiga) is a relatively new member of the SGLT2 class of diabetes medications, which was a significant advancement from the earlier class known as thiazolidinediones, such as Pioglitazone (the generic name for Actos). Dapagliflozin was first approved by the FDA in 2014. Farxiga operates by blocking reabsorption of glucose in the kidneys, thereby allowing more glucose to be eliminated from the body through urine. This mechanism effectively lowers blood sugar levels and assists in weight loss. Farxiga has selective influence on renal glucose reabsorption with only minor effects on insulin resistance or pancreatic beta-cell function, resulting in it having fewer side effects than other antidiabetic drugs like Actos that have stronger impacts on these two aspects of diabetes management.
What conditions is Farxiga approved to treat?
Farxiga is FDA-approved for the management of several health conditions:
- Type 2 diabetes mellitus, as an adjunct to diet and exercise
- Reduced risk of hospitalization for heart failure in patients with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors
- To improve glycemic control in adults along with diet and exercise when both diet and exercise alone does not provide adequate glycemic control.
How does Farxiga help with these illnesses?
Farxiga aids in managing type 2 diabetes by prompting the kidneys to excrete glucose from the body through urine. It accomplishes this by inhibiting a protein called sodium-glucose co-transporter 2 (SGLT2). SGLT2 is responsible for reabsorbing glucose back into the bloodstream, thus preventing its elimination via urine. By blocking SGLT2, Farxiga ensures that more glucose can be expelled from your system and does not accumulate excessively in your blood. Glucose, besides being an essential energy source for cells, when present at high levels over time in individuals with diabetes, can lead to numerous health problems including heart disease, kidney damage, and nerve complications. Therefore, by helping eliminate excess glucose via urine, Farxiga assists patients manage their condition and maintain healthy blood sugar levels.
What is Actos?
Actos, a brand name for pioglitazone, is an oral anti-diabetic medication that acts primarily by decreasing insulin resistance. It accomplishes this by increasing the peripheral uptake of glucose and reducing the output of glucose from the liver. Pioglitazone was first approved by the FDA in 1999 as a second-generation thiazolidinedione (TZD) designed to enhance insulin sensitivity in patients with Type 2 diabetes. As a TZD drug, Actos does not increase insulin production but instead focuses on improving how your body uses its own natural insulin or any additional insulin you take. This means it's distinct from other classes of diabetic medications such as DPP-4 inhibitors like Farxiga that work to reduce glucose levels in different ways. The side-effect profile is also unique: unlike Farxiga which can potentially cause genital yeast infections and urinary tract infections due to increased sugar excretion via urine, Actos may lead to weight gain and fluid retention—a known risk factor for heart failure—though it generally has lower risks for hypoglycemia.
What conditions is Actos approved to treat?
Actos is approved by the FDA for the management of:
- Type 2 diabetes mellitus as monotherapy
- Type 2 diabetes mellitus in combination with insulin, metformin, or a sulfonylurea when diet and exercise plus the single agent does not result in adequate glycemic control.
How does Actos help with these illnesses?
Actos, also known as pioglitazone, is an oral diabetes medication that helps control blood sugar levels. It works by improving the sensitivity of your body to insulin, a naturally occurring hormone in your body that allows cells to use glucose for energy. This action is important in managing type 2 diabetes where the body either resists the effects of insulin or doesn't produce enough insulin to maintain normal glucose levels. Unlike Farxiga which works by helping kidneys remove glucose from bloodstream, Actos focuses on enabling effective utilization of available insulin. Therefore, it might be prescribed when patients do not respond adequately to medications like metformin or sulfonylureas, and can also be used in combination with these drugs if needed.
How effective are both Farxiga and Actos?
Both dapagliflozin (Farxiga) and pioglitazone (Actos) are key players in the management of type 2 diabetes, but they were approved by the FDA about a decade apart and have different mechanisms of action. Dapagliflozin works as an SGLT-2 inhibitor that prevents glucose reabsorption in kidneys while pioglitazone is a thiazolidinedione that increases insulin sensitivity.
Research shows both drugs effectively control blood sugar levels, however their side effect profiles differ significantly. A study published in Diabetes Care journal concluded that dapagliflozin was associated with weight loss and blood pressure reduction without significant hypoglycemia when compared to placebo. Moreover, several studies have indicated its potential benefits on heart failure outcomes.
On the other hand, Actos has been linked with weight gain - a common side effect for TZD class medications due to fluid retention and increased subcutaneous adipose tissue. Its use also requires caution due to associations with bone fractures especially among post-menopausal women, bladder cancer risk though this concern remains controversial following subsequent conflicting findings from long term studies.
To sum it up, choice between Farxiga or Actos would likely be influenced by individual patient characteristics including cardiovascular disease status or risks thereof, kidney function status as well as personal preferences concerning medication tolerability including propensity to gain weight.
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At what dose is Farxiga typically prescribed?
Oral dosages of Farxiga typically range from 5-10 mg/day, and research suggests that a daily dose of 5 mg is usually effective in managing type 2 diabetes for most adults. Children under the age of 18 should not use this medication unless directed by a healthcare provider. For individuals on this treatment who do not see an improvement in their blood sugar levels after several weeks, the dosage can be increased to a maximum of 10 mg per day as recommended by their doctor. Conversely, Actos dosages vary more widely, generally ranging from 15–45 mg/day based on individual needs and response to therapy. Similar to Farxiga, children should not take Actos unless specifically instructed by their healthcare provider.
At what dose is Actos typically prescribed?
Actos (pioglitazone) treatment for type 2 diabetes is generally initiated at a dosage of 15-30 mg per day. The dose can then be increased to a maximum of 45 mg per day, based on the patient's glycemic response and tolerance level. This medication should be taken once daily and without regard to meals. Patients taking Actos should have their blood sugar levels monitored regularly, especially during the first few weeks of treatment or if the dose is altered in any way. If there isn't any significant improvement in glycemic control after a few weeks, your healthcare provider might reassess your treatment plan.
What are the most common side effects for Farxiga?
Common side effects of Farxiga can include:
- Dehydration and lightheadedness
- Yeast infections (Genital or Urinary Tract)
- Changes in urination, including urgent need to urinate more often, in larger amounts, or at night.
- Nausea or vomiting inability to eat or severe abdominal pain
- Low blood sugar (hypoglycemia) when used with insulin or insulin secretagogues
- Kidney problems
- Increased LDL cholesterol levels
Conversely, Actos may have these common side effects:
- Swelling of legs and feet due to fluid retention
- Weight gain related to fluid retention and increased fat stores
- Upper respiratory tract infection symptoms like sore throat and sinusitis -Anemia.
Are there any potential serious side effects for Farxiga?
Farxiga, like most medications, can cause some side effects. Some individuals may experience:
- Dehydration symptoms such as severe dizziness, fainting, or light-headedness
- Symptoms of urinary tract infections such as burning sensation when urinating, pelvic pain in women and rectal pain in men
- Signs of a serious allergic reaction: rash; itching/swelling (especially of the face/tongue/throat); severe dizziness; difficulty breathing
There are also rare but serious side effects that include signs of other infections (such as fever, persistent sore throat), unusual tiredness or weakness.
In contrast with Actos which has been linked to bladder cancer and heart failure among other potential risks. If taking either Farxiga or Actos you should be aware of these potential risks and discuss them thoroughly with your healthcare provider before making any decisions about medication.
What are the most common side effects for Actos?
Actos, another medication used in the management of type 2 diabetes, can lead to some differing side effects. You may experience:
- Mild nausea or stomach upset
- Weight gain (as it aids in controlling blood sugar levels)
- Headache and muscle pain
- Increased risk for fractures especially in women
- Upper respiratory tract infections like stuffy nose, sore throat
- Sinusitis and pharyngitis It's worth noting that whilst these side effects are potential risks, many people using Actos do not experience serious adverse reactions. However, if you notice symptoms such as vision changes or yellowing eyes/skin while on Actos, seek immediate medical attention.
Are there any potential serious side effects for Actos?
Though Actos is generally considered safe, some individuals may experience severe side effects. If you observe any of the following, it could indicate a serious reaction:
- Signs of an allergic response including hives, itching or difficulty breathing.
- Rapid weight gain and swelling (particularly in your hands or feet).
- An unexpected fracture in women
- Stomach pain and blood in urine - which might be signs of bladder cancer.
- Shortness of breath even after mild exertion.
- Chest discomfort and feelings of weakness, particularly on one side of the body
- Slurred speech or unclear vision.
If you notice any such symptoms while taking Actos, immediately seek medical attention. Remember that maintaining open communication with your healthcare provider can help manage your condition effectively.
Contraindications for Farxiga and Actos?
Both Farxiga and Actos are medications used to manage Type 2 diabetes, but as is the case with all medicines, they may have different effects on individuals. If you notice any severe adverse reactions or worsening of your diabetes symptoms while taking either medication, it’s crucial to seek immediate medical attention.
Neither Farxiga nor Actos should be taken if you’re undergoing treatment for bladder cancer or have a history of this disease due to potential aggravation. Always inform your doctor about any other medications you're currently taking; certain drugs might interact adversely with Farxiga or Actos.
Patients who've been using diuretics (water pills) should exercise caution when starting therapy with these drugs as both can lead to dehydration and low blood pressure. Also noteworthy is that patients having liver disease must use Actos judiciously because its clearance from the system may be prolonged leading to increased drug levels in the body. For those prone to urinary tract infections or genital yeast infections, there's an elevated risk when taking Farxiga since it works by removing sugar through urine.
How much do Farxiga and Actos cost?
For brand name versions of these drugs:
- The price for 30 tablets of Farxiga (10 mg) averages around $610, which works out to approximately $20/day.
- The price for 30 tablets of Actos (15 mg) is about $470, translating to roughly $16/day.
Thus, if you are prescribed the standard dosage for each medication, then brand-name Actos is less expensive on a per-day treatment basis. However, cost should not be your primary consideration when determining which drug is most suitable; effectiveness and potential side effects also matter significantly.
Generic versions do exist and can save you money:
- Dapagliflozin (generic Farxiga) in packs of 28 tablets costs from about $1.50 to $2 per day at typical dosages.
- Pioglitazone (generic Actos), available in packs ranging from 14 up to 500 capsules with the cost starting as low as approximately $0.50 per day and not exceeding about $1/day depending upon the pack size chosen upfront.
Popularity of Farxiga and Actos
Dapagliflozin, known by the brand name Farxiga, is a relatively new medication for type 2 diabetes that was prescribed to roughly 4 million people in the US in 2020. Dapagliflozin belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors, which lower blood sugar levels by causing the kidneys to remove sugar from the body through urine. It has been gaining traction among physicians due its additional benefits on heart failure and kidney disease.
Pioglitazone, sold under the brand name Actos, has been used as a treatment for type 2 diabetes for several years now. In contrast with dapagliflozin’s mechanism of action, pioglitazone works primarily by decreasing insulin resistance in tissues. Approximately 8 million prescriptions were filled for this drug in the US during 2020 alone. Pioglitazone holds just under half of overall thiazolidinedione prescriptions - a class of drugs known for their ability to improve glycemic control - but concerns about potential side effects like weight gain and bone fractures have slowed its growth over recent years.
Conclusion
Both Farxiga (dapagliflozin) and Actos (pioglitazone) are widely used in the treatment of type 2 diabetes, with numerous clinical studies showing their effectiveness in controlling blood sugar levels. They can be used individually or as an addition to other diabetes medications under the careful consideration of a healthcare provider, due to potential interactions. The two drugs work differently; Farxiga functions by helping kidneys get rid of glucose through urine while Actos improves insulin sensitivity.
Farxiga is often considered when metformin alone does not provide sufficient control over blood sugar levels, whereas Actos may be prescribed for those who cannot tolerate metformin or have contraindications against using it.
Both medications are available in generic form allowing for significant cost savings especially for patients without insurance cover. Both Farxiga and Actos require time before they fully take effect so immediate results should not be expected.
The side effects between the two vary; common ones include urinary tract infections and yeast infections for Farxiga since it increases urination, while weight gain and fluid retention are more associated with Actos use. It's crucial that patients closely monitor their blood sugar levels during treatment initiation period or dosage changes and seek medical help immediately if any severe reactions occur.
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Refrences
- Vivian, E. M. (2015, March 1). Dapagliflozin: A new sodium–glucose cotransporter 2 inhibitor for treatment of type 2 diabetes. American Journal of Health-System Pharmacy. Oxford University Press (OUP).http://doi.org/10.2146/ajhp140168
- Waugh, J., Keating, G. M., Plosker, G. L., Easthope, S., & Robinson, D. M. (2006). Spotlight on Pioglitazone in Type 2 Diabetes Mellitus1. Treatments in Endocrinology. Springer Science and Business Media LLC.http://doi.org/10.2165/00024677-200605030-00006
- Tan, M., Johns, D., González Gálvez, G., Antúnez, O., Fabián, G., Flores-Lozano, F., … Herz, M. (2004, May). Effects of pioglitazone and glimepiride on glycemic control and insulin sensitivity in Mexican patients with type 2 diabetes mellitus: A multicenter, randomized, double-blind, parallel-group trial. Clinical Therapeutics. Elsevier BV.http://doi.org/10.1016/s0149-2918(04)90068-9
- Davis, P. N., Ndefo, U. A., & Oliver, A. (2015, January 21). Dapagliflozin. Journal of Pharmacy Practice. SAGE Publications.http://doi.org/10.1177/0897190014566308