acarbose, Precose (cont.)

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Medical and Pharmacy Editor:

DOSING: The recommended initial acarbose dose is 25 mg three times daily. The dose is then increased every four to eight weeks based on response and tolerance. The maximum dose is 50 mg three times daily for patients weighing 60 kg or less and 100 mg three times daily for those weighing more than 60 kg. 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 a patient has cirrhosis.

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 (Lanoxin) 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 drug, 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. Charcoal may absorb acarbose and digestive enzyme preparations such as amylase or pancreatin may breakdown acarbose and should not be adminstered with acarbose.

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 women who are breastfeeding.

Medically reviewed by Eni Williams, PharmD

REFERENCE: FDA Prescribing Information

Medically Reviewed by a Doctor on 4/7/2015

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