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

Most common
upper respiratory tract infection (up to 13.2%)
headache (up to 9.1%)
sinusitis (up to 6.3%)
myalgia (up to 5.4%)

Amaryl

Most common
hypoglycemia (up to 19.7%)
headache (5% or more)
dizziness (5% or more)
asthenia (5% or more)

Actos vs. Amaryl Dosage

Actos

Dosage
Dosage Table
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

Dosage
Dosage Table
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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