Actos vs. Glipizide

See how Actos and Glipizide compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Actos is a thiazolidinedione taken once daily and does not cause low blood sugar on its own, while glipizide is a sulfonylurea that can trigger hypoglycemia.

  • Actos carries a boxed warning for heart failure and costs far more per month than glipizide, one of the least expensive diabetes drugs on the market.

  • Glipizide lowers blood sugar faster than Actos but comes with a higher risk of hypoglycemia, especially in older or medically fragile patients.

Actos vs. Glipizide Drug Summary

Actos

Actos (pioglitazone) is a thiazolidinedione that helps the body use its own insulin more effectively in adults with type 2 diabetes. It is taken as a single tablet once a day, alone or with other diabetes medications, and does not cause low blood sugar when used by itself.

Glipizide

Glipizide is a sulfonylurea that prompts the pancreas to release more insulin, lowering blood sugar in adults with type 2 diabetes. It comes as an immediate-release tablet taken once or twice daily, or an extended-release tablet taken once daily, alongside diet and exercise.

Actos vs. Glipizide 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%)

Glipizide

Most common
Dizziness (up to 2%)
Drowsiness (up to 2%)
Headache (up to 2%)
Nausea (up to 1.4%)

Actos vs. Glipizide 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

Glipizide

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg once daily At the start
Maximum dose 5-20 mg once daily If needed
Dose changes 5 increases As tolerated

Actos vs. Glipizide Indications

Actos

Actos is FDA-approved to lower blood sugar in adults with type 2 diabetes, used alone or combined with other diabetes medications. Doctors sometimes prescribe it off-label for nonalcoholic fatty liver disease, including NASH.

  • Type 2 diabetes, as monotherapy

  • Type 2 diabetes, combined with metformin, insulin, or other agents

  • Off-label: nonalcoholic fatty liver disease and NASH

  • Not approved for type 1 diabetes or diabetic ketoacidosis

Glipizide

Glipizide is FDA-approved to lower blood sugar in adults with type 2 diabetes, used as an add-on to diet and exercise. It has no established off-label uses and is not approved for other conditions.

  • Type 2 diabetes, as an add-on to diet and exercise

  • Type 2 diabetes, often combined with metformin or other agents

  • Not approved for type 1 diabetes or diabetic ketoacidosis

  • No common off-label uses

Actos vs. Glipizide Pros and Cons

Actos

Actos does not cause hypoglycemia on its own and is taken as a single once-daily tablet. It carries a boxed warning for heart failure risk and costs considerably more per month than glipizide.

Pros

  • Does not cause low blood sugar when used alone

  • Simple once-daily dosing with only two maintenance steps

  • May help reduce liver fat in off-label NASH use

Cons

  • Boxed warning for heart failure, contraindicated in NYHA Class III or IV

  • Increased bladder cancer risk with long-term use

  • Increased fracture risk in women

  • Costs roughly $588 to $700 per month without insurance

Glipizide

Glipizide has decades of clinical use and is one of the least expensive diabetes medications available. It works quickly to lower blood sugar but carries a real risk of hypoglycemia, especially in older or medically fragile patients.

Pros

  • Costs roughly $10 to $35 per month without insurance

  • Works quickly, with doses adjustable every few days

  • Available in both immediate-release and extended-release forms

Cons

  • Can cause hypoglycemia, especially in elderly or kidney-impaired patients

  • Sulfonylureas as a class carry a possible cardiovascular mortality signal

  • Extended-release tablets cannot be crushed, chewed, or split

  • No off-label uses to fall back on if diabetes control needs change

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