miglitol, Glyset (cont.)

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Medical and Pharmacy Editor:

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.

Medically Reviewed by a Doctor on 3/6/2013


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