Short answer: Both contain pioglitazone.12 Actoplus Met adds metformin in a 15 mg/850 mg tablet taken with meals, up to three a day; Actos is one tablet once daily. Actoplus Met's boxed warning covers congestive heart failure and lactic acidosis; Actos's covers heart failure. Its label found the tablet bioequivalent to Actos 15 mg taken with metformin.
| Actoplus Met | Actos | |
|---|---|---|
| What is in it | Pioglitazone 15 mg and metformin 850 mg per tablet1 | Pioglitazone 15, 30 or 45 mg2 |
| How taken | With meals; one tablet once or twice daily to start1 | Once daily, with or without meals2 |
| Maximum | Three tablets a day: pioglitazone 45 mg and metformin 2,550 mg1 | 45 mg once daily2 |
| With gemfibrozil | Up to one tablet once daily1 | Up to 15 mg daily2 |
| Before starting | Liver tests1 | Liver tests2 |
| HbA1c change, 24 weeks (Actoplus Met label) | Actoplus Met 15/850 mg twice daily: −1.81 | Pioglitazone 15 mg twice daily: −1.01 |
| Diarrhea in that trial | 9.0%1 | 2.6% on pioglitazone alone1 |
| Missed dose | Do not double; take the next dose as prescribed1 | Do not double the next day; take the next dose as prescribed2 |
| Boxed warning | WARNING: CONGESTIVE HEART FAILURE and LACTIC ACIDOSIS1 | WARNING: CONGESTIVE HEART FAILURE2 |
In a 24-week trial of 600 people not controlled on diet and exercise, Actoplus Met 15/850 mg, pioglitazone 15 mg and metformin 850 mg were each taken twice daily. HbA1c fell 1.8, 1.0 and 1.0 points, and 64%, 47% and 39% reached 7% or less. Diarrhea was 9.0%, 2.6% and 15.3%. The pioglitazone arm was not called Actos.1
Separately, the label's blood level studies found the 15/850 mg tablet bioequivalent to "ACTOS® 15 mg" taken with immediate-release metformin 850 mg in healthy people.1
Both labels list heart failure, swelling, liver failure, bladder tumors, fractures in women and macular edema from pioglitazone.12 Actoplus Met adds the metformin warnings: lactic acidosis, no use with an eGFR below 30 and no starting at 30 to 45, stopping around some contrast scans and while food and fluids are restricted, and lower vitamin B12.1
Which, if either, fits is for your prescriber. More detail: Actoplus Met side effects, Actos side effects, the Actoplus Met and Actos dosing schedules, the Actos missed-dose page and Pioglitazone vs metformin: how do they compare?.