Short answer: Both are once-daily tablets for blood sugar control in adults with type 2 diabetes.12 Actos (pioglitazone), a thiazolidinedione at 15 to 45 mg, has a boxed warning that it can cause or worsen heart failure. Jardiance (empagliflozin), an SGLT2 inhibitor at 10 or 25 mg, is also approved to lower heart failure and kidney risks and for children 10 and older. Neither label reports a trial against the other.
| Actos | Jardiance | |
|---|---|---|
| Drug and class | Pioglitazone, a thiazolidinedione1 | Empagliflozin, an SGLT2 inhibitor2 |
| Approved for | Blood sugar control in adults with type 2 diabetes1 | Blood sugar control in adults and children 10 and older with type 2 diabetes; lowering heart and kidney risks in heart failure, chronic kidney disease, and type 2 diabetes with heart disease2 |
| Dose | Start 15 or 30 mg once daily; up in 15 mg steps to 45 mg1 | 10 mg once daily in the morning; up to 25 mg for more blood sugar control2 |
| Food | With or without meals1 | With or without food2 |
| Most common side effects | Alone vs placebo: upper respiratory infection 13.2% vs 8.5%, headache 9.1% vs 6.9%, muscle pain 5.4% vs 2.7%1 | Urinary tract infection 9.3% on 10 mg vs 7.6% on placebo; genital yeast infection in women 5.4% and 6.4% vs 1.5%2 |
| Weight and swelling | Dose-related swelling and weight gain, highest with insulin1 | More urination 3.4% and 3.2% vs 1.0%; thirst 1.7% and 1.5% vs 0%2 |
| Missed dose | Do not double the dose the next day1 | Take as soon as possible; skip if the next dose is near; do not double2 |
| Boxed warning | Congestive heart failure1 | None2 |
Actos can cause dose-related fluid retention that can lead to or worsen heart failure; it is not recommended with symptomatic heart failure, and starting it with NYHA Class III or IV heart failure is contraindicated. Its label also covers liver failure reports, possible bladder tumor risk, macular edema, and more fractures in women (5.1% vs 2.5% on placebo in PROactive).1 Jardiance warns about ketoacidosis, which can occur with near-normal blood sugar, fluid loss and low blood pressure, genital and urinary infections including Fournier's gangrene, low blood sugar with insulin or a sulfonylurea, and lower limb amputation, and it is held for at least 3 days before surgery when possible.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Yes, in one Jardiance label trial. With pioglitazone, with or without metformin, over 24 weeks, any low blood sugar was 1.2% on Jardiance 10 mg and 2.4% on 25 mg vs 1.8% on placebo, with no severe episodes.2 That trial added Jardiance or placebo to pioglitazone; it did not compare the two drugs against each other.
Which, if either, fits is for your prescriber. More detail: Actos side effects, Jardiance side effects, the Actos and Jardiance dosing schedules, the Actos and Jardiance missed-dose pages, Actos vs Januvia: how do the two diabetes tablets differ? and Jardiance vs Farxiga: how do the two SGLT2 tablets compare?.