Trulicity vs. Actos

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

Key Takeaways

  • Trulicity is a once-weekly injection that also lowers cardiovascular risk, while Actos is a once-daily pill with no proven heart benefit.

  • Trulicity's main side effects are gastrointestinal, while Actos is more linked to fluid retention, heart failure risk, and bone fractures in women.

  • Actos has a low-cost generic option, while Trulicity has no generic and a higher monthly list price.

Trulicity vs. Actos Drug Summary

Trulicity

Trulicity (dulaglutide) is a GLP-1 receptor agonist used to control blood sugar in adults and children 10 and older with type 2 diabetes. It also reduces the risk of major cardiovascular events in adults with heart disease or multiple cardiovascular risk factors. It is given as a once-weekly injection using a prefilled pen.

Actos

Actos (pioglitazone) is a thiazolidinedione (TZD) used to control blood sugar in adults with type 2 diabetes, either alone or with other diabetes medications. It works by improving how the body responds to insulin. It is taken as a once-daily tablet.

Trulicity vs. Actos Side Effects

Trulicity

Most common
nausea (up to 21.1%)
diarrhea (up to 13%)
vomiting (up to 13%)
abdominal pain (up to 13%)

Actos

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

Trulicity vs. Actos Dosage

Trulicity

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.75 mg once weekly Weeks 1-4
Maximum dose 4.5 mg once weekly If needed
Dose changes 3 increases Every 4 weeks

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

Trulicity vs. Actos Indications

Trulicity

Trulicity is approved to help adults and children age 10 and older with type 2 diabetes manage their blood sugar. It is also approved to lower the risk of heart attack, stroke, or cardiovascular death in adults who already have heart disease or several cardiovascular risk factors. Some doctors prescribe it off-label for weight loss in people without diabetes.

  • Type 2 diabetes blood sugar control (ages 10+)

  • Reduces cardiovascular risk in high-risk adults

  • Off-label: weight management

  • Not approved for type 1 diabetes or DKA

Actos

Actos is approved to help adults with type 2 diabetes manage their blood sugar, either as a standalone treatment or combined with other diabetes drugs. It is sometimes used off-label to treat nonalcoholic fatty liver disease (NAFLD) or NASH. It is not approved for children or for type 1 diabetes.

  • Type 2 diabetes blood sugar control (adults only)

  • Can be used alone or with other diabetes drugs

  • Off-label: nonalcoholic fatty liver disease (NAFLD/NASH)

  • Not approved for type 1 diabetes or DKA

Trulicity vs. Actos Pros and Cons

Trulicity

Trulicity offers cardiovascular protection on top of blood sugar control, which sets it apart from oral diabetes pills like Actos. Its main tradeoff is a needle-based routine and gastrointestinal side effects that are common early in treatment.

Pros

  • Proven to lower cardiovascular event risk

  • Only needs to be taken once a week

  • Approved for children 10 and older

  • Often supports modest weight loss

Cons

  • Requires a weekly injection instead of a pill

  • No generic version, so it costs more

  • Common nausea, vomiting, and diarrhea during titration

  • Roughly $987 to $1,065 per month without insurance

Actos

Actos is a low-cost oral pill that works well for people who want to avoid injections, and it does not cause low blood sugar on its own. Its tradeoffs are a boxed warning for heart failure and long-term risks like bladder cancer and bone fractures.

Pros

  • Taken as a simple once-daily pill

  • Available as a cheap generic

  • Does not cause hypoglycemia when used alone

  • Roughly $588 to $700 per month without insurance

Cons

  • Boxed warning for causing or worsening heart failure

  • Long-term use raises bladder cancer risk

  • Increases fracture risk, especially in women

  • No proven cardiovascular benefit

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