Short answer: Actos is taken once daily, with or without meals. The label starting dose is 15 mg or 30 mg, or 15 mg in people with NYHA Class I or II heart failure. It can go up in 15 mg steps, based on HbA1c, to a maximum of 45 mg once daily, or 15 mg with gemfibrozil. A missed dose is not doubled the next day.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Actos is approved for: Actos is a thiazolidinedione approved, along with diet and exercise, to improve blood sugar control in adults with type 2 diabetes (section 1). It works only when the body still makes insulin, so it is not for type 1 diabetes or diabetic ketoacidosis, and it is not recommended for children (section 8.4).
Source
ACTOS (pioglitazone) tablets, for oral use, prescribing information and Medication Guide. Takeda Pharmaceuticals America. DailyMed, version published April 9, 2025. DailyMed setid d2ddc491-88a9-4063-9150-443b4fa4330c
Actos is a tablet taken by mouth once daily, without regard to meals. It comes in 15 mg, 30 mg and 45 mg tablets (sections 2.1 and 3).
Liver tests (ALT, AST, alkaline phosphatase and total bilirubin) are done before starting. Routine repeat liver tests are not recommended in people without liver disease (section 2.1).
After starting or raising the dose, people are watched for weight gain, swelling and signs of heart failure (section 2.1).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Situation | Dose |
|---|---|
| Starting dose, no congestive heart failure | 15 mg or 30 mg once daily |
| Starting dose, congestive heart failure (NYHA Class I or II) | 15 mg once daily |
| Step-up | Increments of 15 mg, based on glycemic response as determined by HbA1c |
| Maximum | 45 mg once daily |
| With gemfibrozil or other strong CYP2C8 inhibitors | Maximum 15 mg daily |
If low blood sugar occurs with a sulfonylurea, the sulfonylurea dose is lowered. If it occurs with insulin, the insulin dose is lowered by 10% to 25%, then adjusted to blood sugar.
Gemfibrozil raises pioglitazone exposure about 3-fold, so the maximum Actos dose with a strong CYP2C8 inhibitor is 15 mg daily.
If a CYP2C8 inducer such as rifampin is started or stopped, diabetes treatment may need changes, without going above 45 mg of Actos daily.
Topiramate lowers pioglitazone levels; blood sugar control is watched when they are used together.
Tablets are stored at 25 C (77 F), with excursions from 15 to 30 C, in a tightly closed container protected from light, moisture and humidity.
If a dose is missed on one day, the dose should not be doubled the following day. The Medication Guide says: if you miss a dose of Actos, take your next dose as prescribed unless your doctor tells you differently; do not take two doses at one time the next day.
More on this: missed a dose of Actos.
In Dose Track you set up Actos as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.