miglitol, Glyset

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Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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GENERIC NAME: miglitol

BRAND NAME: Glyset

DRUG CLASS AND MECHANISM: Miglitol is an oral medication used to control blood glucose (sugar) levels in type 2 diabetes. It belongs to a class of drugs called alpha-glucosidase inhibitors which also includes acarbose (Precose). Carbohydrates that are eaten are digested by enzymes in the intestine into smaller sugars which are absorbed into the body and raise 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. Miglitol 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. The FDA approved miglitol in December 1996.

GENERIC: No

PRESCRIPTION: Yes

PREPARATIONS: Tablets: 25, 50 and 100 mg.

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

PRESCRIBED FOR: It is believed that strict control of blood sugar in people with diabetes decreases the risk of eye, kidney, and nerve damage. Alpha-glucosidase inhibitors are used to help control blood sugar levels that are not controlled by diet and exercise alone. Miglitol is used for treating type 2 diabetes alone or in combination with a sulfonylurea such as glyburide (Diabeta).

DOSING: The initial miglitol dose may start at 25 mg three times daily and then increase after four to eight weeks to 50-100mg three times daily. Some patients may benefit from starting at 25 mg once daily to reduce the occurrence of upset stomach. Miglitol should be taken at the first bite of each meal. Smaller doses may be adequate for patients with severe kidney dysfunction. Miglitol therapy is not advised in the presence of certain medical conditions such as inflammatory bowel disease (Crohn's disease or ulcerative colitis) or intestinal obstruction and chronic intestinal diseases involving difficulty with digestion or absorption such as Crohn's disease.

Miglitol 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 during a prolonged period of time.)

DRUG INTERACTIONS: Miglitol may interfere with digoxin (Lanoxin) absorption thereby decreasing digoxin blood levels and its effect. Therefore, the digoxin dose may need to be increased if miglitol is begun.

Miglitol also may reduce the effectiveness of ranitidine (Zantac) and propranolol (Inderal). An adjustment in dose based on monitoring of the patient may be necessary if miglitol is used with either of these drugs.

Intestinal adsorbents (for example, charcoal) and digestive enzymes (for example, amylase, pancreatin) may reduce the effect of miglitol and should not be taken concomitantly.

Adding a sulfonylurea during therapy with miglitol may lower blood glucose further, and the risk for developing hypoglycemia is greater. Caution should be used when combining these drugs.

If mild to moderate hypoglycemia occurs while taking miglitol in combination with a sulfonylurea, oral glucose (dextrose) should be used for treatment instead of sucrose (table sugar). Since miglitol blocks the digestion of sucrose to glucose, hypoglycemia will not be rapidly corrected if sucrose is given. Miglitol alone does not produce hypoglycemia.

PREGNANCY: There are no safety and efficacy studies in humans. Insulin therapy is recommended during pregnancy.

NURSING MOTHERS: Miglitol is excreted in human breast milk in small amounts. Drug exposure to the infant is expected although in small amounts. Miglitol is not recommended for nursing mothers.

SIDE EFFECTS: The most common side effects of miglitol are abdominal pain, diarrhea and flatulence. Rare but possible side effects include low serum iron and skin rash.

Reference: FDA Prescribing Information

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