Actos vs. Amaryl
See how Actos and Amaryl compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Actos is a once-daily thiazolidinedione that doesn't cause hypoglycemia on its own but carries a boxed warning for heart failure risk.
Amaryl is a once-daily sulfonylurea that lowers blood sugar effectively but can cause hypoglycemia, especially if meals are skipped.
Both drugs treat type 2 diabetes only, not type 1 diabetes or diabetic ketoacidosis, and both are available as low-cost generics.
Actos vs. Amaryl Drug Summary
Actos
Actos (pioglitazone) is a thiazolidinedione that helps control blood sugar in adults with type 2 diabetes by improving the body's response to insulin. It's taken as a once-daily oral tablet, either alone or with other diabetes medications. Unlike sulfonylureas, it doesn't cause hypoglycemia when used by itself.
Amaryl
Amaryl (glimepiride) is a sulfonylurea that lowers blood sugar by prompting the pancreas to release more insulin in adults with type 2 diabetes. It's taken as a once-daily oral tablet, often alongside diet and exercise or other diabetes medications. Because it increases insulin release, it carries a hypoglycemia risk that Actos does not.
Actos vs. Amaryl Side Effects
Actos
Amaryl
Actos vs. Amaryl Dosage
Actos
Amaryl
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | At the start |
| Maximum dose | 45 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg or 2 mg once daily | At the start |
| Maximum dose | 8 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Actos
| STAGE | DOSE | WHEN |
| Starting dose | 15 mg once daily | At the start |
| Maximum dose | 45 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Amaryl
| STAGE | DOSE | WHEN |
| Starting dose | 1 mg or 2 mg once daily | At the start |
| Maximum dose | 8 mg once daily | If needed |
| Dose changes | 2 increases | As tolerated |
Actos vs. Amaryl Indications
Actos
Actos is FDA-approved to improve blood sugar control in adults with type 2 diabetes, either alone or combined with other diabetes medications. It's also used off-label for nonalcoholic fatty liver disease (NASH). It is not approved for type 1 diabetes or diabetic ketoacidosis.
Type 2 diabetes blood sugar control, alone or in combination
Off-label use for nonalcoholic fatty liver disease (NASH)
Not approved for type 1 diabetes
Not approved for diabetic ketoacidosis
Amaryl
Amaryl is FDA-approved as an add-on to diet and exercise to improve blood sugar control in adults with type 2 diabetes. It's the only sulfonylurea approved to be combined with insulin when sulfonylurea or insulin alone isn't enough. It is not approved for type 1 diabetes or diabetic ketoacidosis.
Type 2 diabetes blood sugar control, add-on to diet/exercise
Only sulfonylurea approved for combo with insulin
Not approved for type 1 diabetes
Not approved for diabetic ketoacidosis
Actos vs. Amaryl Pros and Cons
Actos
Actos carries a boxed warning for heart failure and added risks of bladder cancer and bone fractures, but it doesn't cause low blood sugar on its own. It's a once-daily pill that can also help with fatty liver disease off-label, though it typically costs more out of pocket than sulfonylureas like Amaryl.
Pros
Does not cause hypoglycemia when taken alone
Sometimes used off-label for fatty liver disease (NASH)
No cardiovascular mortality signal like older sulfonylureas
Cons
Boxed warning for heart failure risk
Increased risk of bladder cancer with long-term use
Increased fracture risk in women
Roughly $588 to $700 per month without insurance, before savings programs
Amaryl
Amaryl is a low-cost, once-daily option that's the only sulfonylurea approved for use alongside insulin, but it carries a real risk of hypoglycemia. It also carries a small increased cardiovascular mortality risk based on older sulfonylurea data and, rarely, serious allergic reactions.
Pros
Only sulfonylurea approved for combo with insulin
Long duration of action allows once-daily dosing
Roughly $15 to $110 per month without insurance, before savings programs
Cons
Can cause severe hypoglycemia, especially with missed meals
Possible increased cardiovascular mortality risk per older sulfonylurea data
Risk of hemolytic anemia in patients with G6PD deficiency
Rare but serious allergic reactions, including Stevens-Johnson syndrome
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