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

Most common
Genital yeast infection (up to 11%)
Urinary tract infection (up to 6%)
Increased urination (up to 5%)
Male genital yeast infection (up to 4%)

Actos

Most common
Headache (up to 9.1%)
Sinusitis (up to 6.3%)
Myalgia (up to 5.4%)
Tooth disorder (up to 5.3%)

Invokana vs. Actos Dosage

Invokana

Dosage
Dosage Table
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

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

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

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.