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Actos Vs Metformin Side Effects

Best Treatments For Type 2 Diabetes

Best Treatments For Type 2 Diabetes

At-a-glance Six classes of oral medicines (and 12 individual drugs) are now available to help the 25.8 million people in the U.S. with type 2 diabetes control their blood sugar when diet and lifestyle changes are not enough. Our evaluation of these medicines found the following: Newer drugs are no better. Two drugs from a class called the sulfonylureas and a drug named metformin have been around for more than a decade and work just as well as newer medicines. Indeed, several of the newer drugs, such as Januvia and Onglyza, are less effective than the older medications. Newer drugs are no safer. All diabetes pills have the potential to cause adverse effects, both minor and serious. The drugs’ safety and side effect “profiles” may be the most important factor in your choice. The newer drugs are more expensive. The newer diabetes medicines cost many times more than the older drugs. Taking more than one diabetes drug is often necessary. Many people with diabetes do not get enough blood sugar control from one medicine. Two or more may be necessary. However, taking more than one diabetes drug raises the risk of adverse effects and increases costs. Taking effectiveness, safety, adverse effects, dosing, and cost into consideration, we have chosen the following as Consumer Reports Best Buy Drugs if your doctor and you have decided that you need medicine to control your diabetes: Metformin and Metformin Sustained-Release — alone or with glipizide or glimepiride Glipizide and Glipizide Sustained-Release — alone or with metformin Glimepiride — alone or with metformin These medicines are available as low-cost generics, costing from $4 to $35 a month. If you have been diagnosed with diabetes, we recommend that you try metformin first unless it's inappropriate for your hea Continue reading >>

Efficacy And Safety Of Pioglitazone Versus Metformin In Patients With Type 2 Diabetes Mellitus: A Double-blind, Randomized Trial.

Efficacy And Safety Of Pioglitazone Versus Metformin In Patients With Type 2 Diabetes Mellitus: A Double-blind, Randomized Trial.

Efficacy and safety of pioglitazone versus metformin in patients with type 2 diabetes mellitus: a double-blind, randomized trial. Department of Medicine I, Rudolfstiftung Hospital, A-1030 Vienna, Austria. [email protected] J Clin Endocrinol Metab. 2004 Dec;89(12):6068-76. Pioglitazone increases the insulin sensitivity of peripheral tissues and may provide an alternative first-line treatment for type 2 diabetes. This study compared metabolic control in drug-naive type 2 diabetes patients given either pioglitazone or metformin. Eleven hundred and ninety-nine patients with poorly controlled type 2 diabetes mellitus [glycosylated hemoglobin (HbA1c), 7.5-11%; normal, 4.3-6.1%] were randomized to receive either pioglitazone (< or =45 mg/d) or metformin (< or =850 mg, three times daily). HbA1c, fasting plasma glucose (FPG), insulin levels, total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol, triglycerides, free fatty acids, and urinary albumin/creatinine ratio were measured. Mean HbA1c decreased in both treatment groups from baseline to wk 52 (-1.4% and -1.5%). Significantly greater mean reductions in FPG were observed in the pioglitazone group (-45.0 mg/dl; -2.5 mmol/liter) than in the metformin (-39.6 mg/dl; -2.2 mmol/liter) group (P = 0.016). Favorable changes in triglycerides and HDL-C were more pronounced with pioglitazone. Although low density lipoprotein cholesterol and TC levels increased with pioglitazone, TC/HDL-C ratios decreased similarly with both treatments. The urinary albumin/creatinine ratio was reduced by 19% with pioglitazone treatment, but remained unchanged with metformin therapy (-1%; P = 0.002). There was an increase in body weight of 1.9 kg in the pioglitazone group and a decrease of 2 Continue reading >>

Actos, Invokana, Metformin: What Type 2 Diabetes Drug's Right For You?

Actos, Invokana, Metformin: What Type 2 Diabetes Drug's Right For You?

Type 2 diabetes is debilitating for many, ushering in a world of needles, side effects and medications. Since insulin resistance causes excess glucose to build up in your blood, most diabetes medications combat this issue. The most popular type 2 diabetes drugs are Invokana (canagliflozin), Metformin (Glucophage) and Actos (pioglitazone). Each medication uses a different mechanism to help regulate blood sugar. However, some blood sugar drugs have serious side effects that worsen over time. Among Metformin, Invokana and Actos, which type 2 diabetes drug is right for you? There are many different type 2 diabetes medications, but these three are the most popular and commonly prescribed. New American College of Physicians (ACP) guidelines recommend Metformin for managing diabetes symptoms. This endorsements backed by data from the latest diabetes studies. The ACP also recommends combining Metformin with other drugs to manage type 2 diabetes, if necessary. Metformin, unless contraindicated, is an effective treatment strategy because it has better effectiveness, is associated with fewer adverse effects, and is cheaper than most other oral medications, said ACP president Dr. Nitin Damle. Dr. Damle adds that while U.S. obesity rates escalate, so too does type 2 diabetes prevalence. Metformin has the added benefit of being associated with weight loss, explains Dr. Damle. Metformin comes highly recommended by physicians nationwide and is the cheapest, most effective type 2 diabetes drug available. Invokana works with your kidneys to help you eliminate excess blood sugar through urination. This helps decrease blood sugar levels without increasing your likelihood of gaining weight, provided youre getting proper nutrition and exercise. One Invokana benefit is its higher association Continue reading >>

Common Side Effects Of Actoplus Met, Actoplus Met Xr (pioglitazone Hcl And Metformin Hcl) Drug Center - Rxlist

Common Side Effects Of Actoplus Met, Actoplus Met Xr (pioglitazone Hcl And Metformin Hcl) Drug Center - Rxlist

The dose of Actoplus MET is individualized on the basis of effectiveness and tolerability. The maximum recommended daily dose is pioglitazone 45 mg/metformin 2550 mg. Hyperglycemia ( high blood sugar ) may result if you take Actoplus MET with drugs that raise blood sugar, such as: isoniazid , diuretics (water pills), steroids, phenothiazines, thyroid medicine, birth control pills and other hormones, seizure medicines, and diet pills, or medicines to treat asthma , colds or allergies. Hypoglycemia (low blood sugar) may result if you take Actoplus MET with drugs that lower blood sugar, such as: alcohol, nonsteroidal anti-inflammatory drugs ( NSAIDs ), aspirin or other salicylates, sulfa drugs, monoamine oxidase inhibitors (MAOIs), beta-blockers, or probenecid. It may also interact with furosemide , nifedipine , cimetidine or ranitidine , amiloride or triamterene , digoxin , morphine , procainamide, quinidine, trimethoprim , or vancomycin . Tell your doctor all medications you are taking. During pregnancy, Actoplus MET should be used only when prescribed. Your doctor may direct you to use insulin instead during your pregnancy. This medication can promote ovulation and increase the risk of becoming pregnant. Metformin passes into breast milk in small amounts. It is unknown if pioglitazone passes into breast milk. Consult your doctor before breastfeeding. Our Actoplus MET (pioglitazone hydrochloride and metformin hydrochloride) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. This medication may cause lactic Continue reading >>

Common Side Effects Of Actos (pioglitazone Hydrochloride) Drug Center - Rxlist

Common Side Effects Of Actos (pioglitazone Hydrochloride) Drug Center - Rxlist

Actos is available as tablets in strengths of 15, 30 or 45 mg. Dose is dependent on patient response and the prescribing doctor's clinical judgment; glucose tests may help determine doses. Actos and other similar drugs may exacerbate symptoms of congestive heart failure (dyspnea, edema , weight gain) and these symptoms may be serious. Patients with congestive heart failure classified as III or IV (NY Heart Association) should not take this Actos. Other serious side effects of Actos include nausea, vomiting , jaundice , and vision changes or loss; it may also cause hypoglycemia . There are no good studies in pregnant or breastfeeding women. Use of Actos in these patients should weigh risks versus benefits. There are no studies of safety or effectiveness of Actos on pediatric (under 18 years old) patients. Our Actos Drug Center provides a comprehensive view of available drug information as well as related drugs, user reviews, supplements , and diseases, and conditions. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Fractures [see WARNINGS AND PRECAUTIONS ] Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Over 8500 patients with type 2 diabetes have been treated with ACTOS in randomized, double-blind, controlled clinical trials, including 2605 patients with type 2 diabetes and macrovascular disease treated with ACTOS in the PROactive clinical trial. In these trials, over 6000 patients have been treated with ACTOS for six months or lon Continue reading >>

Pioglitazone/metformin

Pioglitazone/metformin

Pioglitazone/metformin (also known by the brand names Actoplus Met, Piomet and Politor) is combination of two oral diabetes medications pioglitazone and metformin. The two oral antihyperglycemic agents with different mechanisms of action are used to improve glycemic control in patients with diabetes mellitus type 2. Mechanisms[edit] Pioglitazone is a member of the thiazolidinedione class, it decreases insulin resistance in the periphery and in the liver resulting in increased insulin dependent glucose disposal and decreased hepatic glucose output. Metformin is a member of the biguanide class, improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Indication[edit] Pioglitazone/metformin is indicated as an adjunct to diet and exercise: To improve glycemic control in patients with type 2 diabetes, or For patients who are already treated with a separate combination of pioglitazone and metformin, For patients whose diabetes is not adequately controlled with metformin alone, or For patients who have initially responded to pioglitazone alone and require additional glycemic control. Dosage and administration[edit] Recommended dose[edit] Use of antihyperglycemic agents in the management of type 2 diabetes should be individualized on the basis of effectiveness and tolerability. Pioglitazone/metformin should be given with meals; the initial starting dose is either the 15 mg/500 mg or 15 mg/850 mg tablet strength once or twice daily, and gradually titrated after assessing adequacy of therapeutic response, while not exceeding the maximum recommend Continue reading >>

8 Natural Alternatives To Actos And Metformin

8 Natural Alternatives To Actos And Metformin

If you suffer from Type 2 diabetes, there is a good chance that you’ve had a discussion with your doctor about the prescription drug Metformin. It is often initiated at the diagnosis of diabetes and helps to reduce blood sugars in an effective way. The problem however with this solution is its inability to work for everyone. Additionally, many users of Metformin may find the side effects of this drug extremely bothersome. The first thing to remember is that the development of Type 1 diabetes is not your fault, no matter what your medical providers might have you believe. Diabetes is caused by your body’s inability to process, driving up your blood sugars. However, Type 2 diabetes (adult onset) can be avoided many times and even reversed with the right diet, exercise program and proper natural herbs and vitamins. Dealing with High Blood Sugar Levels Maintaining your blood sugar levels into acceptable ranges is critically necessary to maintain your quality of life, which means your routines are going to be changing no matter what you do. High blood sugars can cause nerve and kidney damage, so it is important to act now. Whether you want to avoid prescription medication, or suffer with current side effects, many natural alternatives exist for Metformin. These options may be able to effectively treat your diabetes and help you feel back in control again 8 Natural Alternatives to Metformin 1. Lifestyle Changes: For many that suffer with Type 2 diabetes, basic lifestyle changes are often the primary thing that is necessary for treatment of their disease. For many people, this means an increased level of exercise and an improvement in their overall nutrition. The goal of these lifestyle changes is to get on an effective weight loss plan that is combined with higher levels Continue reading >>

Pioglitazone Vs Metformin Pcos 228474

Pioglitazone Vs Metformin Pcos 228474

Compare Actos vs Metformin Comprehensive Analysis Treato Compare Actos vs. Metformin, which is better for uses like: PCOS, Insulin Resistance and Type 2 Diabetes. Compare head-to-head ratings, side effects, warnings Compare Metformin vs Pioglitazone Treato Compare Metformin vs. Pioglitazone, which is better for uses like: PCOS, Type 2 Diabetes and Insulin Resistance. Compare head-to-head ratings, side effects, warnings Comparison of the Effects of Pioglitazone and Metformin How do pioglitazone and metformin effect hepatic and extra-hepatic insulin action? metformin or actos? which is better? PCOS Message Board I am currently on 2000mg/day of Metformin. Because of the side buy canadian cialis effects I don't really take it regularly, and I was wondering if anyone has used Met and then changed PDF Comparing therapeutic effects of Metformin and Pioglitazone Polycystic ovary syndrome (PCOS) is the most Effects of Metformin and Pioglitazone in PCOS Weight loss, inhibition of ovarian androgen with progestin, PDF buying cialis online COMPARISON OF METFORMIN AND PIOGLITAZONE IN PCOS ResearchGate ORIGINAL ARTICLE Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 15/ April 15, 2013 Page-2532 COMPARISON OF METFORMIN AND PIOGLITAZONE IN when to use metformin or pioglitazone for polycystic ovary There's controversy over when to use metformin or pioglitazone for polycystic ovary syndrome (PCOS). Learn more with Pharmacist's Letter. Compare Actos vs Metformin Iodine.com Actos (pioglitazone) can improve blood sugar control but is not a top choice since it has a lot of side effects. Glucophage (metformin) is the first choice medicine Metformin Vs Actos. 1mgPharmacy: 25mg, 50mg, 100mg, 120mg, 130mg, 150mg, 200mg Dosages. We offers exact generic equivalents of most pop Continue reading >>

Is Actos Safe?

Is Actos Safe?

Q. I recently saw an ad for a lawsuit involving the diabetes drug Actos. Is it safe for me to continue taking it? A. That all depends. Pioglitazone (Actos) and a similar drug, rosiglitazone (Avandia), are in a class of medications known as thiazolidinediones, which are used to treat type 2 diabetes. In August 2012, the U.S. Food and Drug Administration (FDA) approved the first generic versions of pioglitazone. Sign up for the AARP Health Newsletter. Thiazolidinediones — whether used alone or in combination with other antidiabetic agents — can cause or worsen congestive heart failure. For that reason, people with heart failure should not use them, and those with risk factors for heart failure — such as high blood pressure, coronary artery disease, a history of heart attack or irregular heartbeats — should use them with caution. Both Actos and its generic equivalent are labeled with a "black box" safety warning to that effect. The drugs also carry a warning of a possible increased risk of bladder cancer based on the FDA's analysis of five-year results from an ongoing, 10-year study in California. While the analysis found no overall increased risk of bladder cancer associated with the use of pioglitazone, it did find a slightly increased risk among patients with the longest exposure to — and highest cumulative doses of — the drug. So if you have a history of bladder cancer, or have other risk factors for bladder cancer, you also may want to avoid the drugs. Still, pioglitazone works so well in older patients that, in my judgment, the benefits outweigh the possible risks for most people. For the reasons mentioned above, if you take pioglitazone, you and your doctor or other health professional should carefully watch for signs or symptoms of heart failure. These Continue reading >>

Metformin And Pioglitazone

Metformin And Pioglitazone

Metformin and pioglitazone is a combination of two oral diabetes medicines that help control blood sugar levels. Metformin and pioglitazone is for people with type 2 diabetes who do not use daily insulin injections. This medication is not for treating type 1 diabetes . Metformin and pioglitazone may also be used for purposes not listed in this medication guide. Lifestyle Lessons - 9 Tips For Managing Type 2 Diabetes You should not use this medicine if you have severe or uncontrolled heart failure , kidney problems, active bladder cancer , metabolic acidosis , or diabetic ketoacidosis (call your doctor for treatment with insulin ). Metformin and pioglitazone is not for treating type 1 diabetes. Metformin and pioglitazone can cause or worsen congestive heart failure. Call your doctor at once if you have shortness of breath (even with mild exertion), swelling, or rapid weight gain . If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and pioglitazone. Some people develop lactic acidosis while taking metformin. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain , nausea with vomiting , slow or uneven heart rate, dizziness , or feeling very weak or tired. You should not use this medicine if you are allergic to metformin or pioglitazone, or if you have: diabetic ketoacidosis (call your doctor for treatment with insulin). If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and pioglitazone. Be sure your caregivers know ahead of time that you are using this medication. Some peo Continue reading >>

Actos

Actos

Actos (pioglitazone) is an oral Type 2 diabetes drug that lowers blood sugar by decreasing insulin resistance and reducing the amount of glucose made in the liver. This allows the body to better dispose of excess blood sugar. Typically, the dose starts at 15 or 30 mg and is taken once a day, but some people may require a stronger dose. Doctors can increase the strength of the medicine by 15 mg increments to a maximum of 45 mg daily. However, numerous studies and a review by the U.S. Food and Drug Administration (FDA) link higher dosages and prolonged use to an increased risk of bladder cancer and other serious conditions. Actos is not intended to treat Type 1 diabetes or diabetic ketoacidosis. The drug can be used alone or with other Type 2 diabetes medicines such as metformin. There are two additional types of Actos that combine pioglitazone and metformin: Actoplus Met and Actoplus Met XR (extended release). What Does Actos Treat? Actos is approved to treat Type 2 diabetes in adults by improving glycemic (defined as causing glucose – sugar – in the blood) control. The drug comes in a tablet form to be taken by mouth daily and should be used in combination with diet and exercise. People with Type 2 diabetes do not make or use insulin well. Insulin is a hormone produced by the pancreas that regulates the amount of glucose in the blood. It moves blood sugar into cells where it is stored for later use as energy. Type 2 diabetes results in higher than normal levels of glucose because glucose does not enter cells. The body is then unable to use the glucose for energy. Type 2 diabetes is a lifelong (chronic) disease that can develop at any age, including during childhood. However, it mostly occurs in middle-aged and older people. The condition often develops slowly over t Continue reading >>

Avandia And Actos Safety Concerns: What Should I Do?

Avandia And Actos Safety Concerns: What Should I Do?

Avandia and Actos safety concerns: What should I do? I've heard that the Food and Drug Administration has issued cautions about diabetes drugs Avandia and Actos. If I take one of these drugs, what should I do? Avandia and Actos which belong to a class of drugs known as thiazolidinediones are two of many oral medications designed to control blood sugar in those with diabetes. These drugs lower the amount of sugar in your blood by making your tissues more sensitive to insulin, the hormone that regulates the absorption of sugar into your cells. Rosiglitazone (Avandia) and pioglitazone (Actos) were strictly regulated until the end of 2013 because they have been linked to serious risks, including an increased risk of heart attack with Avandia, and of heart failure with Actos. Actos has also been linked to an increased risk of bladder cancer. Because of these risks, the Food and Drug Administration (FDA) issued strong cautions about the use of both of these drugs, and in 2010 restricted the availability of Avandia to people with type 2 diabetes who weren't able to achieve glycemic control with other medications. Those restrictions were reversed in 2013 based on research showing that the risk of heart attack associated with use of Avandia was no greater than that from the standard type 2 diabetes medicines metformin and sulfonylureas. However, the risk of heart failure is still higher with these drugs, so they should be used with caution. If you take or are considering taking either of these drugs, talk with your doctor about what's best for you and review if there may be better alternatives. If Avandia or Actos is already part of your diabetes treatment plan, take the drug as prescribed. Although an increased risk of heart attack, heart failure or bladder cancer is nothing t Continue reading >>

Actos Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - Webmd

Actos Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - Webmd

Sore throat , muscle pain , weight gain, or tooth problems may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: new/worsening vision problems (such as blurred vision ), bone fracture, reddish-colored urine, urgent need to urinate, pain while urinating. Pioglitazone may rarely cause liver disease. Tell your doctor right away if you develop symptoms of liver disease, including: dark urine, yellowing of eyes / skin , persistent nausea / vomiting , stomach / abdominal pain . Pioglitazone does not usually cause low blood sugar ( hypoglycemia ). Low blood sugar may occur if this drug is prescribed with other diabetes medications (such as insulin or a sulfonylurea). Low blood sugar is more likely if you drink large amounts of alcohol, do unusually heavy exercise , or do not consume enough calories from food. To help prevent low blood sugar , eat meals on a regular schedule, and do not skip meals. Check with your doctor or pharmacist to find out what you should do if you miss a meal. Symptoms of low blood sugar include sudden sweating , shaking, fast heartbeat, hunger , blurred vision , dizziness , or tingling hands/feet. It is a good habit to carry glucose tablets or gel to treat low blood sugar . If you don't have these reliable forms of glucose, rapidly raise your blood sugar by eating a quick source of sugar such as table sugar, honey, or candy, or drink fruit juice or non-diet soda. Tell your doctor right away about the reaction and the Continue reading >>

Actos (pioglitazone)

Actos (pioglitazone)

On April 8, 2014, Takeda were fined $6bn for destroying thousands of documents relating to health data about Actos . Takeda's partner, the pharmaceutical company Eli Lilly, has been fined $3 billion for its part in the cover up. Pioglitazone works by making cells more sensitive to insulin, which is used to regulate the level of glucose in the body. Improving insulin sensitivity (or reducing insulin resistance) makes it easier for sugar (glucose) in the blood to get into the cells. Actos is intended for adults with type 2 diabetes - particularly overweight diabetic patients - who are unable to control their blood sugar levels through diet and exercise alone or the use of metformin and/or a sulphonylurea. It is designed to be used alongside a healthy, balanced diet and regular physical activity. In the UK it is available as a standalone treatment (monotherapy), a dual-oral therapy in combination with metformin, or a triple-oral therapy in combination with metformin and a sulphonylurea. Actos may also be used in combination with insulin for type 2 diabetics who are unable to control their blood sugars on insulin alone or cannot tolerate meformin. Actos should never be used by diabetic patients who: are allergic or sensitive to any of the ingredients in the medicine or other thiazolidinediones have a heart condition, such as heart attack, or a history of heart problems have bladder cancer or history of bladder cancer It is also important to note that Actos is ineffective and possibly harmful in type 1 diabetes . Actos is administered orally with or without food. The drug is available in 15 mg, 30mg and 45mg tablet doses. The correct dosage set by your prescriber is printed on the pharmacy label, along with instructions on how often take your medicine. You should not change Continue reading >>

Actos - Lawsuit Information & The Common Side Effects

Actos - Lawsuit Information & The Common Side Effects

Actos is the brand name of pioglitazone, an oral anti-diabetic used to treat Type II or Non-Insulin Dependent Diaetes Mellitus (NIDDM). Though it is effective in treating Type II diabetes, especially when used along with dietary and lifestyle medications it has been linked to serious side effects, some of which may be dangerous or life threatening. Concerns about the medication have arisen over adverse events such as kidney disease, bladder cancer and congestive heart failure. Another member of the same thiazolidinedione (TZD) class of anti-diabetic medications, Avandia (rosiglitazone) has also been the subject of intensive investigation in both the United States and Europe. Because this class of medications has proven to be so dangerous, the FDA placed temporary restrictions on the use of Avandia and has required that a black-box warning be placed on Actos. The black-box warning on Actos warns that people with a history of heart failure should not use the medication. The FDA also required that the Warnings and Precautions section of the prescription information for Actos be updated to include notice about the possibility of bladder cancer in those who have used it for over one year. Takeda is one of the top 20 largest pharmaceutical companies in the world. They partnered with Eli Lilly to market Actos and in 2011, sales reached $3.85 billion in the U.S. alone. Before the drug lost patent protection and became available for generic use, it made up 27 percent of the manufacturers yearly revenue and was the best-selling anti-diabetic medication in the U.S. Takeda has received thousands of lawsuits by patients who have been diagnosed with bladder cancer. These lawsuits state that the manufacturer, Takeda, had knowledge of the dangers of Actos and failed to adequately warn Continue reading >>

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