Invokana vs. Actos
See how Invokana and Actos compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Invokana is an SGLT2 inhibitor that also lowers heart failure and kidney disease risk, while Actos is a thiazolidinedione that mainly targets insulin resistance.
Invokana carries a boxed warning for lower-limb amputation, while Actos carries a boxed warning for heart failure.
Invokana most often causes genital yeast infections and UTIs, while Actos most often causes upper respiratory infections and headaches.
Invokana vs. Actos Drug Summary
Invokana
Invokana (canagliflozin) is an SGLT2 inhibitor that lowers blood sugar in adults and children 10 and older with type 2 diabetes by causing the kidneys to remove excess glucose through urine. It is also approved to reduce cardiovascular risk in people with heart disease and to slow diabetic kidney disease. It is taken as a tablet once a day, with the dose sometimes increased after several weeks.
Actos
Actos (pioglitazone) is a thiazolidinedione that improves the body's sensitivity to its own insulin to control blood sugar in adults with type 2 diabetes. It is taken as a tablet once a day, alone or combined with other diabetes medications like metformin or insulin. It carries a boxed warning for heart failure and is not used in patients with more advanced heart failure.
Invokana vs. Actos Side Effects
Invokana
Actos
Invokana vs. Actos Dosage
Invokana
Actos
| STAGE | DOSE | WHEN |
| Starting dose | 100 mg once daily | At the start |
| Maximum dose | 100 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
| 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 |
Invokana
| STAGE | DOSE | WHEN |
| Starting dose | 100 mg once daily | At the start |
| Maximum dose | 100 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
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 |
Invokana vs. Actos Indications
Invokana
Invokana is FDA-approved to improve blood sugar control in adults and children 10 and older with type 2 diabetes. It is also approved to reduce the risk of major cardiovascular events in adults with type 2 diabetes and heart disease, and to slow the progression of diabetic kidney disease, including reducing heart failure hospitalizations.
Type 2 diabetes in adults and children 10 and older
Reduce risk of major cardiovascular events with heart disease
Slow progression of diabetic kidney disease
Reduce risk of heart failure hospitalization with kidney disease
Actos
Actos is FDA-approved to improve blood sugar control in adults with type 2 diabetes, used alone or with other diabetes medications. It is sometimes prescribed off-label for nonalcoholic fatty liver disease, though this use is not FDA-approved. Actos is not approved for type 1 diabetes or diabetic ketoacidosis.
Type 2 diabetes in adults, as monotherapy or combination therapy
Used with metformin, sulfonylureas, or insulin
Off-label: fatty liver disease (NAFLD/NASH), not FDA-approved
Not approved for type 1 diabetes or ketoacidosis
Invokana vs. Actos Pros and Cons
Invokana
Invokana stands out among diabetes pills for proven cardiovascular and kidney protection, backed by large outcome trials. It carries a boxed warning for lower-limb amputation and commonly causes genital yeast infections, so it is not the right fit for everyone.
Pros
Reduces risk of major cardiovascular events in patients with heart disease
Slows progression of diabetic kidney disease and cuts heart failure hospitalizations
Often causes modest weight loss instead of weight gain
Simple once-daily tablet with only two dose strengths
Cons
Boxed warning for increased risk of lower-limb amputation
Commonly causes genital yeast infections and urinary tract infections
Risk of dehydration, low blood pressure, and rare diabetic ketoacidosis
Dose must be reduced or avoided as kidney function declines
Actos
Actos is a low-cost, well-established option that does not cause low blood sugar on its own, making it useful for patients wary of hypoglycemia. Its boxed warning for heart failure and long-term bladder cancer risk mean it is avoided in patients with existing heart or bladder problems.
Pros
Does not cause low blood sugar when used alone
Available as a low-cost generic tablet, unlike most branded diabetes drugs
Long track record with over two decades of clinical use
No genital infection risk since it doesn't work through the kidneys
Cons
Boxed warning for causing or worsening congestive heart failure
Contraindicated in patients with advanced (Class III or IV) heart failure
Increased risk of bladder cancer with long-term use
Increased fracture risk in women and common fluid retention or weight gain
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