Actos, also known as Pioglitazone, is a prescription drug approved by the FDA to treat type 2 diabetes mellitus. Actos is prescribed in combination with diet and exercise to lower the amount of glucose in the bloodstream and to reduce insulin resistance. Actos can be used in treatment alone or in combination with another diabetes drug. Manufactured by Japanese drug company Takeda Pharmaceuticals, Actos was the tenth best selling drug in the US in 2008, with sales of over $2.4 billion and $4.8 billion worldwide. Although some research has suggested that Actos is safer than the competing drug Avandia for risk of cardiac events, other studies have indicated that a dangerous possible side effect of Actos is an increased risk of bladder cancer. As a result, Actos has been subject to recalls in Europe. In the US, the FDA issued a drug safety communication to inform the public of the potential risk of bladder cancer, ordered an Actos safety review, and required updated drug label safety warnings. Actos bladder cancer lawsuits against Takeda Pharmaceuticals have recently begun and are expected to increase as potential cases of bladder cancer among Actos patients are investigated.