Medications and Drugs

GENERIC NAME: acarbose

BRAND NAME: Precose

DRUG CLASS AND MECHANISM: Acarbose is an oral medication that is used to control blood glucose (sugar) levels in type II diabetes. It belongs to a class of drugs called alpha-glucosidase inhibitors which also includes miglitol (Glyset). Acarbose was approved by the FDA for use in 1995.

Carbohydrates that are eaten are digested by enzymes in the intestine into smaller sugars which are absorbed into the body and increase blood sugar levels. The process of carbohydrate digestion requires the pancreas to release into the intestine alpha-amylase enzymes which digest the large carbohydrates into smaller carbohydrates called oligosaccharides. The cells lining the small intestine then release alpha-glucosidase enzymes that further digest the oligosaccharides into smaller sugars, like glucose, that can be absorbed. Acarbose is a man-made oligosaccharide designed to slow down the actions of alpha-amylase and alpha-glucosidase enzymes thereby slowing the appearance of sugar in the blood after a meal.

GENERIC: Yes

PRESCRIPTION: Yes

PREPARATIONS: Tablets: 25, 50 and 100 mg.

STORAGE: Acarbose should be stored at room temperature, 15-30°C(59-86°F) in a tight container.

PRESCRIBED FOR: It is believed that strict sugar control in diabetics decreases the risk of eye, kidney, and nerve damage. Alpha-glucosidase inhibitors are used to help lower blood sugar levels that are not controlled by diet and exercise. Acarbose can be used alone to treat type II diabetes or can be combined with sulfonylureas such as glyburide (Diabeta) or metformin (Glucophage) or with insulin.

DOSING: The initial acarbose dose may start 25 mg three times daily and then increase after four to eight weeks to 50-100 mg three times daily. Acarbose should be taken at the first bite of each meal.

Smaller doses may be adequate for patients with severe kidney dysfunction or liver disease. Acarbose is not recommended if cirrhosis is present. Acarbose therapy is not advised in the presence of certain medical conditions such as inflammatory bowel disease or intestinal obstruction and chronic intestinal diseases that interfere with digestion or absorption such as Crohn's disease.

Acarbose doses should be adjusted based upon blood glucose levels taken one hour after a meal and blood HbA1c levels taken about three months after starting or changing the dose. (HbA1c is a chemical in the blood that is a good indicator of blood glucose control.)

DRUG INTERACTIONS: Acarbose may interfere with digoxin absorption thereby decreasing digoxin blood levels and its effect. Therefore, the digoxin dose may need to be increased if acarbose is begun.

Since adding insulin or a sulfonylurea to acarbose therapy may lower blood glucose more than acarbose alone, the risk for developing hypoglycemia is greater when these drugs are combined. Caution should be used when combining these drugs.

If mild to moderate hypoglycemia occurs while taking acarbose in combination with another anti-diabetic agent, the hypoglycemia should be treated with oral glucose (dextrose) instead of sucrose (table sugar) because acarbose blocks the digestion of sucrose to glucose, and hypoglycemia will not be corrected rapidly with sucrose. Acarbose alone does not produce hypoglycemia.

PREGNANCY: There are no studies of acarbose treatment during pregnancy in humans. Insulin therapy is recommended in pregnancy.

NURSING MOTHERS: Acarbose is excreted in the milk of lactating animals, but no human studies have been conducted. Acarbose use is not recommended for nursing mothers.

SIDE EFFECTS: The most common side effects with acarbose therapy are abdominal pain, diarrhea and flatulence. There is a rare possibility that these gastrointestinal side effects may become severe and progress to paralytic ileus.

Other possible but rare side effects are an increase in liver enzymes, and decreases in hematocrit, calcium or vitamin B6 levels.

Reference: FDA Prescribing Information

Last Editorial Review: 4/28/2001 11:14:00 AM

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