Jardiance vs. Actos

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

Key Takeaways

  • Jardiance is an SGLT2 inhibitor with added FDA approvals for heart failure and chronic kidney disease, while Actos is a thiazolidinedione approved only for blood sugar control.

  • Actos carries a boxed warning for causing or worsening heart failure and is contraindicated in advanced heart failure, while Jardiance has no such warning and is actually approved to treat heart failure.

  • Jardiance can occasionally cause diabetic ketoacidosis or genital infections, while Actos is more often linked to fluid retention, bone fractures in women, and a small increase in bladder cancer risk.

Jardiance vs. Actos Drug Summary

Jardiance

Jardiance (empagliflozin) is an SGLT2 inhibitor that lowers blood sugar by causing the kidneys to remove excess glucose through urine. It is taken as one oral tablet daily and also carries FDA approvals for reducing cardiovascular death, treating heart failure, and slowing chronic kidney disease.

Actos

Actos (pioglitazone) is a thiazolidinedione that improves the body's response to insulin, helping muscle and fat cells use blood sugar more effectively. It is taken as one oral tablet daily and is FDA-approved only for blood sugar control in type 2 diabetes, alone or with other diabetes drugs.

Jardiance vs. Actos Side Effects

Jardiance

Most common
hypoglycemia with insulin/SU (up to 41.3%)
volume depletion related reactions (up to 11.4%)
urinary tract infection (up to 9.3%)
female genital mycotic infection (up to 5.4%)

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%)

Jardiance vs. Actos Dosage

Jardiance

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg once daily At the start
Maximum dose 25 mg once daily If needed
Dose changes 1 increase As tolerated

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

Jardiance vs. Actos Indications

Jardiance

Jardiance is FDA-approved for blood sugar control in adults and children 10 and older with type 2 diabetes. It also carries approvals for reducing cardiovascular death in people with heart disease, treating heart failure regardless of ejection fraction, and slowing chronic kidney disease progression.

  • Type 2 diabetes blood sugar control (adults and children 10+)

  • Reduce cardiovascular death risk in adults with heart disease

  • Heart failure: reduce CV death and hospitalization risk

Actos

Actos is FDA-approved only for blood sugar control in adults with type 2 diabetes, used alone or combined with other diabetes medications. It is sometimes prescribed off-label for nonalcoholic fatty liver disease, though this use is not FDA-approved.

  • Type 2 diabetes blood sugar control as monotherapy

  • Type 2 diabetes blood sugar control combined with other drugs

  • Off-label: nonalcoholic fatty liver disease/NASH (not FDA-approved)

Jardiance vs. Actos Pros and Cons

Jardiance

Jardiance's clinical profile extends beyond diabetes into heart failure and kidney protection, which most oral diabetes drugs cannot claim. It does not typically cause hypoglycemia on its own, though the risk rises when combined with insulin or sulfonylureas.

Pros

  • FDA-approved for heart failure and chronic kidney disease, not just diabetes

  • Approved for cardiovascular death risk reduction in heart disease

  • No boxed warning for heart failure

Cons

  • Can cause genital yeast infections and urinary tract infections

  • Risk of diabetic ketoacidosis, even with normal blood sugar

  • Rare risk of serious genital infection (Fournier's gangrene)

  • Not recommended in later pregnancy due to fetal kidney risk

Actos

Actos improves insulin sensitivity without directly triggering the pancreas, so it doesn't cause hypoglycemia on its own. Its long-term risks, including fluid retention, fractures, and bladder cancer, make it a less common first choice than newer diabetes drugs like Jardiance.

Pros

  • Does not cause hypoglycemia when used alone

  • Available as a low-cost generic (pioglitazone)

  • Long track record of use since 1999

Cons

  • Boxed warning for causing or worsening heart failure

  • Contraindicated in NYHA Class III or IV heart failure

  • Increased risk of bladder cancer with long-term use

  • Increased fracture risk in women

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