Trade Names:Precose- Tablets 25 mg- Tablets 50 mg- Tablets 100 mgGlucobay (Canada)
Inhibits intestinal enzymes that digest carbohydrate, thereby reducing carbohydrate digestion after meals. This lowers postprandial glucose elevation in diabetics.
Less than 2% is absorbed as active drug. T max is approximately 1 h.
Metabolized within the GI tract by intestinal bacteria and digestive enzymes. At least 13 metabolites have been separated from urine specimens, with 1 being active.
Less than 2% is recovered in the urine as active. The plasma elimination t ½ is approximately 2 h. Drug accumulation does not occur with 3 times daily oral dosing.
In those with Ccr less than 25 mL/min per 1.73 m 2 , the C max was approximately 5 times higher, and the AUC was 6 times larger. Treatment with acarbose is not recommended.Elderly
AUC and C max are approximately 1.5 times higher in the elderly, although not statistically significant.
Patients with non-insulin-dependent diabetes mellitus who have failed dietary therapy. May be used alone or in combination with sulfonylureas, insulin, or metformin.
Diabetic ketoacidosis; cirrhosis; inflammatory bowel disease; colonic ulceration; intestinal disorders of digestion or absorption; partial or predisposition to intestinal obstruction; conditions that may deteriorate as a result of increased intestinal gas production.
PO 25 mg 3 times daily with the start of each meal. To minimize GI adverse reactions, some patients may benefit from more gradual dose titration. This may be achieved by initiating treatment at 25 mg daily and increasing the frequency to achieve 25 mg 3 times daily. Increase by 25 mg/dose at 4- to 8-wk intervals, according to response, up to a max based on blood glucose response (max, 150/day if no more than 60 kg, 300 mg/day if above 60 kg).
Store tablets at controlled room temperature (less than 77°F). Protect from moisture.
May lead to loss of glucose control.Intestinal adsorbents (eg, charcoal); digestive enzymes
May lower the efficacy of acarbose.
None well documented.
Flatulence (74%); diarrhea (31%); abdominal pain (19%).
Elevated serum transaminases rarely associated with jaundice.
Hypersensitivity skin reactions such as rash, edema (rare); decreased hematocrit; low serum calcium; low plasma vitamin B 6 levels.
Acarbose does not produce hypoglycemia; however, hypoglycemia may develop if used together with sulfonylureas or insulin. Check blood sugars frequently and observe for signs of hypoglycemia. Inform health care provider if blood sugar readings are outside target range or if hypoglycemic events are noted. Be prepared to treat hypoglycemic reactions with IV or oral glucose instead of cane sugar (table sugar) because absorption of cane sugar is inhibited by acarbose.
Category B . Insulin is recommended to maintain blood glucose levels during pregnancy.
Safety and efficacy not established.
Acarbose plasma concentrations may increase relative to the degree of renal function impairment.
In long-term studies (up to 12 mo, and including acarbose doses up to 300 mg 3 times daily), treatment-emergent elevations of serum transaminases (AST and/or ALT) above ULN, greater than 1.8 times the ULN, and greater than 3 times the ULN occurred in acarbose-treated patients. Although these differences between treatments were statistically significant, these elevations were asymptomatic, reversible, more common in women, and, in general, were not associated with other evidence of liver dysfunction. Serum transaminase elevations appeared to be dose related. In studies including acarbose doses up to the max approved dose of 100 mg 3 times daily, treatment-emergent elevations of AST and/or ALT at any level of severity were similar between acarbose-treated patients and placebo-treated patients.
Certain medical conditions (eg, surgery, fever, infection, trauma) and drugs (eg, diuretics, corticosteroids, oral contraceptives) affect glucose control. In these situations, it may be necessary to adjust dose of acarbose and other antidiabetic drugs.
Increased flatulence, diarrhea, abdominal discomfort.
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