This will be the first time I'm using the brand name for a medication in my post. If you remember from a few weeks ago, I told you that Actos is now available as a generic called pioglitazone. Since the generic is so new and most of you will still know this drug by the name Actos, I'm going to make things easier and call it by its brand name. Actos is one of two drugs in the category known as the TZDs. I won't bother spelling out the name of the class for you here, because quite frankly it is just a mouthful, but if you are curious you can read my previous post about it here.
How does it lower blood sugar: Actos lowers the amount of glucose in your blood by making your cells more sensitive to insulin. As a reminder, insulin is the hormone that opens the door to your cell, allowing glucose in. Think of insulin as a butler and the glucose in your blood as guests wanting to get into the house (cell). In type 2 diabetes, your cells do not recognize insulin very well (the butler is left out in the cold, and so are the guests!). But Actos helps the cell recognize the insulin so that it can do its job, kind of like the maid opening the door for the butler (forgive my pathetic analogy, but I bet you'll remember how Actos works now!).
Another interesting thing about Actos is how it affects your fat cells. We have two types of fat in our bodies - subcutaneous and visceral. Subcutaneous fat exists right underneath your skin. Visceral fat is deeper in your body and surrounds your organs (liver, stomach, and even streaking in your muscles). This visceral fat is the "bad" kind of fat - big amounts of it are related to type 2 diabetes and heart disease. Visceral fat cells are less sensitive to insulin, and subcutaneous fat cells are more sensitive. Actos actually cause your body to produce less visceral fat cells and more subcutaneous fat cells! This means that more glucose can be pulled out of your blood!
The effect on your numbers: Actos can lower your A1c by 1-2% (an A1c of 9.5 could go down to 8.5 or 7.5 with Actos). However, it does take at least 4-8 weeks to see an affect on your A1c, and it might even take up to 16 weeks to see the full effectiveness of the medicine. What's the other number that Actos can affect? Weight. Actos can cause weight gain of about 12 pounds, or more depending upon what other diabetic medications you are taking.
Dosing: Actos is usually started at a dose of 15 mg once daily. You can take Actos with or without food (Actos does not cause hypoglycemia like some of the meds I've already talked about!). If your A1c does not come down far enough after 6-8 weeks, then we will increase the dose or try another medication. Doses can be increased up to a maximum of 45 mg taken once daily. However, doses over 30 mg are not usually effective and may cause more side effects.
Side effects: So what are the side effects of Actos? I've already mentioned one - weight gain. This is due mainly to a buildup of fluid in your body (usually legs and feet) called edema. Fortunately this stabilizes after you've been on Actos for about six months, but your doctor might put you on a "water pill" to help get that extra fluid out of your body. Other side effects that you might notice when on Actos are headache, upper respiratory infection, and bone fracture.
A unique side effect of Actos is that it can cause ovulation and menstruation in women that previously were not ovulating or menstruating. This includes women who are premenopausal and those with polycystic ovary syndrome (PCOS). It is important that women taking Actos are aware of this because Actos should not be taken when pregnant, so doctors will advise them to take adequate precautions.
Who should not take Actos: The most major precaution with Actos has to do with the heart. If you have congestive heart failure, talk to your doctor about whether or not Actos is right for you. Actos can cause fluid to build up in the lungs, or even lead to heart failure, in patients with a bad heart. This has found to be even more of a concern with the other drug in this class (Avandia) that I will talk about next week, but it is important to know about Actos. Generally we can control this fluid buildup by adding a "water pill" and decreasing your Actos dose, but sometimes we will have to try other medications instead of Actos.
Actos can cause liver toxicity, so patients with liver problems should not take Actos. Actos is not effective for patients with type 1 diabetes or those type 2 diabetics that are no longer producing their own insulin. Due to a risk of potential bladder cancer caused by long periods on Actos and high doses, patients with active or prior bladder cancer should not take this medicine.
Drug interactions: It is possible that Actos may decrease the effectiveness of oral birth control. Other medications that can interact with Actos include the cholesterol medications Lipitor and gemfibrozil, the antibiotic ketoconazole, and thyroid medications. As always, this is not the full list and every patient is different, so consult with your local doctor and pharmacist regarding other medications that you are taking.
Monitoring: As always, you should be checking your blood sugars on a daily basis when on Actos. Your doctor will also be checking your A1c to see how your diabetes is being controlled. Also, you can expect liver tests when taking Actos, to make sure that it is not causing problems. We will also watch for fluid buildup in your legs and feet and will monitor bone health, especially in elderly women, to try to prevent fractures.
Place in therapy for diabetes: Currently Actos is considered the second step for a patient after diet, exercise, and metformin have failed. We will usually give metformin a trial run for three months and then switch to either insulin, one of the sulfonylureas that I've already talked about, or a TZD like Actos. Actos is considered for patients that have trouble with low blood sugars, because the sulfonylureas and insulin cause more hypoglycemia. And now that Actos is generic, it will soon become a cost-effective choice. However, be aware that up to 25% of patients not see any effect on their A1c from Actos, so we might have to try another medication.
If you'd like to read more about Actos (and see a really cool video showing how it works!), visit the manufacturer's website here.
Next week I will talk about the other TZD. This is the medication that you might be seeing on television commercials, and not for a good reason! So come back next week and I will break down the rumors and truths about Avandia.
As always, if you have any questions concerning type 2 diabetes and medications, feel free to leave a comment or email me at DrK@solutionsfort2diabetes.com
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As a disclaimer, I am your “virtual” pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your “first opinion” when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
Showing posts with label pioglitazone. Show all posts
Showing posts with label pioglitazone. Show all posts
Sunday, October 7, 2012
Saturday, September 22, 2012
A New Generic!
I won't be fully discussing Actos for a few more weeks, but I wanted to let you know that it is now available as a generic! What does this mean? Lower price for the same medicine!
You can access the article here.
The generic for Actos, pioglitazone, has now been approved by the Food and Drug Administration (FDA) for sale within the United States. You see, when medications first come out for use in the US, they can only be produced by one company. The company that spent the money developing the drug and applying for approval by the FDA is allowed to market their drug exclusively for a certain amount of time, under a brand name. After a certain number of years, this patent expires and other companies can apply to the FDA for approval of their generics to the original drug.
Many patients do not have a full understanding of generic medications. I have many customers that will only buy brand name medications because their belief is that generics are inferior products. And I can understand the confusion. Think about it, you buy store brand facial tissue and it doesn't ever seem to hold up as well as Kleenex, does it? Generic cereal never tastes the same as the brand name product, right? In these cases, generic sometimes signals "low quality."
This isn't the case with medications. The FDA requires all generic medications to be held to as high of standards as brand name medications. They go through an approval process that requires manufacturers to prove that the drug in the generic product is the same as in the name brand. The active ingredient, the "drug," must be identical chemically in both products.
The next time you are in the store, pick up a box of Aleve and a box of its generic "naproxen". Turn to the part where it lists the active ingredients. On both, you will find the words "naproxen sodium 220 mg." This is the main ingredient, the drug that is helping with your pain. Your generic facial tissue company can use as much or little paper to make their product as they want, but if a box says it is generic for Aleve, it will have 220 mg of naproxen in it.
You will notice that the inactive ingredients might be a bit different between the two boxes. Inactive ingredients are basically just fillers - they give the tablet its shape, color, and form. They are considered inactive because they do not do anything to change how the active ingredient, the naproxen in this case, works. Each company uses different fillers to make their tablets, but they don't affect how the medicine works. If they did, they would not be approved by the FDA as a "generic" product.
The most important thing to know is that all generics, before being sold in the US, have to be proven to be equivalent to the original brand name product. They can't work "almost as well" as the original - the makers of the generic have to show that they work the same way as the original. The same amount of the drug must reach the patient's blood in the same amount of time in both the name brand and generic for it to be considered equivalent. The generic has to be just as strong, pure, and stable (meaning it does not expire any sooner than the brand name medicine sitting next to it in your medicine cabinet) as the original brand name drug, or it will not be approved.
If you want to read more about what the FDA has to say about generic medications and the approval process, there is a wonderful article on their website here.
What I like to remind people is that generics have been around for many years. When you look at a list of the top 200 medications that were prescribed this year, the vast majority of them are generic medications. Chances are, you are currently taking a generic medication on a daily basis and have probably thought nothing of it. Metformin, our drug of choice for type 2 diabetics, is a generic. Most blood pressure medications that we commonly use are generic (lisinopril, atenolol, metoprolol, amlodipine - any sound familiar? all generics). Cholesterol medications are usually generic too (statins such as simvastatin, pravastatin, lovastatin, and the newest generic atorvastatin).
Most insurance companies won't cover a brand name medication once a generic is available, unless your doctor fills out some paperwork stating why the brand name medication must be used. And with the recent recalls of over-the-counter brand name medications such as Tylenol, generics have become the more easily accesible option for many patients. They are less expensive and work just as well as the brand name products.
So patients on Actos, rejoice because there is now a cheaper alternative! If you haven't been switched to the generic yet, talk to your pharmacist about when it might be available to you. Some insurance companies take about a month to six months to officially "recognize" the generic and add it to their plan, so it might take a bit of patience. But soon, you will be saving money and living a better life!
-------------------------------------------------------------------------------------------
As a disclaimer, I am your "virtual" pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your "first opinion" when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
You can access the article here.
The generic for Actos, pioglitazone, has now been approved by the Food and Drug Administration (FDA) for sale within the United States. You see, when medications first come out for use in the US, they can only be produced by one company. The company that spent the money developing the drug and applying for approval by the FDA is allowed to market their drug exclusively for a certain amount of time, under a brand name. After a certain number of years, this patent expires and other companies can apply to the FDA for approval of their generics to the original drug.
Many patients do not have a full understanding of generic medications. I have many customers that will only buy brand name medications because their belief is that generics are inferior products. And I can understand the confusion. Think about it, you buy store brand facial tissue and it doesn't ever seem to hold up as well as Kleenex, does it? Generic cereal never tastes the same as the brand name product, right? In these cases, generic sometimes signals "low quality."
This isn't the case with medications. The FDA requires all generic medications to be held to as high of standards as brand name medications. They go through an approval process that requires manufacturers to prove that the drug in the generic product is the same as in the name brand. The active ingredient, the "drug," must be identical chemically in both products.
The next time you are in the store, pick up a box of Aleve and a box of its generic "naproxen". Turn to the part where it lists the active ingredients. On both, you will find the words "naproxen sodium 220 mg." This is the main ingredient, the drug that is helping with your pain. Your generic facial tissue company can use as much or little paper to make their product as they want, but if a box says it is generic for Aleve, it will have 220 mg of naproxen in it.
You will notice that the inactive ingredients might be a bit different between the two boxes. Inactive ingredients are basically just fillers - they give the tablet its shape, color, and form. They are considered inactive because they do not do anything to change how the active ingredient, the naproxen in this case, works. Each company uses different fillers to make their tablets, but they don't affect how the medicine works. If they did, they would not be approved by the FDA as a "generic" product.
The most important thing to know is that all generics, before being sold in the US, have to be proven to be equivalent to the original brand name product. They can't work "almost as well" as the original - the makers of the generic have to show that they work the same way as the original. The same amount of the drug must reach the patient's blood in the same amount of time in both the name brand and generic for it to be considered equivalent. The generic has to be just as strong, pure, and stable (meaning it does not expire any sooner than the brand name medicine sitting next to it in your medicine cabinet) as the original brand name drug, or it will not be approved.
If you want to read more about what the FDA has to say about generic medications and the approval process, there is a wonderful article on their website here.
What I like to remind people is that generics have been around for many years. When you look at a list of the top 200 medications that were prescribed this year, the vast majority of them are generic medications. Chances are, you are currently taking a generic medication on a daily basis and have probably thought nothing of it. Metformin, our drug of choice for type 2 diabetics, is a generic. Most blood pressure medications that we commonly use are generic (lisinopril, atenolol, metoprolol, amlodipine - any sound familiar? all generics). Cholesterol medications are usually generic too (statins such as simvastatin, pravastatin, lovastatin, and the newest generic atorvastatin).
Most insurance companies won't cover a brand name medication once a generic is available, unless your doctor fills out some paperwork stating why the brand name medication must be used. And with the recent recalls of over-the-counter brand name medications such as Tylenol, generics have become the more easily accesible option for many patients. They are less expensive and work just as well as the brand name products.
So patients on Actos, rejoice because there is now a cheaper alternative! If you haven't been switched to the generic yet, talk to your pharmacist about when it might be available to you. Some insurance companies take about a month to six months to officially "recognize" the generic and add it to their plan, so it might take a bit of patience. But soon, you will be saving money and living a better life!
-------------------------------------------------------------------------------------------
As a disclaimer, I am your "virtual" pharmacist, here to provide you with information and answers to questions. However, I am not your local pharmacist and could, in no way, be aware of your specific medical needs. Remember to always check with your medical provider and pharmacist before stopping or starting any new medications. My posts are based on general pharmacy principles and should not considered as your "first opinion" when it comes to your health. Please consult with your doctor and pharmacist about anything regarding your health.
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