Main uses in hair loss: lichen planopilaris (uncommon)

Other names: Actos (trade name)

What is Pioglitazone (Actos)?

  • Pioglitazone (Actos) is a medication that is used for treating diabetes, but has also been found to help patients with scarring alopecia – even those who do not have diabetes.

What is the dose?

  • Check with your physician about the proper dose
  • Many patients with scarring hair loss use 15 mg once daily.
  • Sometimes, the dose can be increased to 30 mg or 45 mg daily (if needed)

Who can not receive Pioglitazone (Actos)?

Pioglitazone (Actos) is usually not prescribed to patients with the following conditions:

  1. Patients with heart failure or previous heart attack
  2. Patients who have type 1 (insulin dependent) diabetes
  3. Patients who are allergic to the drug from previous experience taking it
  4. Patients receiving these medications:  gemfibrozil, rifampin (NOTE: Patients receiving Metformin, a Sulfonylurea or insulin can receive Actos)
  5. Patients who are pregnant or breast feeding
  6. Patients who are under 18 years of age
  7. Patients who have liver problems
  8. Patients who are diabetes and have macular edema (an eye problem)
  9. Patients with a history of many broken or weak bones

What are the side effects of Pioglitazone (Actos)?

Ask the pharmacist for a full list of side effects and also speak to your doctor so you understand all of the potential side effects. These are important ones to be aware of:

  1. Dizziness
  2. Increased risk for upper respiratory tract infections/sinusitis.
  3. Headache, tooth pain, sore throat muscle pain. Contact your doctor if these persist
  4. Weight gain (from fluid retention). It is recommended that you follow your weight while on this medication
  5. Shortness of breath – if this develops contact your doctor
  6. Swelling of the legs (1 out of 20 patients)
  7. Hypoglycaemia (low blood sugar) if receiving other diabetes medications (especially sulfonylureas or insulin). Patients who do not take diabetes medications do not experience low blood sugar
  8. Ovaluation – Female patients taking Actos are more likely to get pregnant because they are more likely to ovulate. Contraception is important if pregnancy is not desired
  9. Drop in the red blood count is rarely reported
  10. Irritation of the liver.   You must stop the medication if you experience dark urine, or change in the color of your stools or persistent abdominal pain, nausea or vomiting
  11. Vision changes and increased risk of fractures was seen in diabetic patients
  12. In diabetics with heart disease risk factors, it is possible that Actos increases the risk for heart attacks, heart failure or strokes.  It is unknown whether this may be an increased risk for healthy patients with scarring alopecia.
  13. Cancer – the risk of certain types of cancer, including bladder cancer may be increased with Prioglitazone. Speak to your doctor about these issues.

You must let a doctor know right away (immediately and seek medical attention) if you develop any of these symptoms

  1.  swelling or fluid retention, especially in the ankles or leg
  2.  shortness of breath or trouble breathing, especially when you lie down.
  3.  an unusually fast increase in weight
  4.  unusual tiredness.

How will I be monitored while on Pioglitazone (Actos)?

  • Before starting, you will have blood tests to make sure that you are healthy to receive actose. These include CBC, liver tests, creatinine (kidney test), fasting blood sugar and HGA1c, CPK
  • You will be seen back in clinic periodically at which time your weight will be recorded.
  • You will be asked if you have experienced swelling of the legs, tiredness
  • You will have blood work done very often for the first month and then less often the following month and then every 3 months. These tests include blood  counts, liver function tests, blood sugars, CPK
  • You’ll be asked to make sure you take sure you take calcium and vitamin D to ensure your bones are healthy

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