Precose (acarbose)

• Acarbose is a prescription oral drug that is used to control blood glucose (sugar) levels in people type 2 diabetes in conjunction with diet, exercise, and other diabetes drugs, for example, metformin (Glucophage) or insulin. It belongs to a class of drugs called alpha-glucosidase inhibitors, which also includes miglitol (Glyset).
• 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.

What brand names are available for acarbose?

• Precose is the brand name available for acarbose.

• The preparation for Precose is an oral tablet medication used in conjunction with diet and exercise for reducing blood sugar in patients with type 2 diabetes.
• Precose can be used alone in the treatment type 2 diabetes or can be combined with sulfonylureas such as glyburide (Diabeta) or metformin (Glucophage) or with insulin.

The most common side effects of include:

• Abdominal pain
• Diarrhea
• Flatulence (gas)
• An increase in liver enzymes

There is a rare possibility that these gastrointestinal side effects may become severe and progress to intestinal obstruction caused by paralysis of the intestinal muscles (paralytic ileus).

Possible serious, but rare side effects of include:

• Decreases in hematocrit, calcium or vitamin B6 levels
• Liver failure
• Jaundice
• Hepatitis
• Ileus
• A reduction in the number of platelets (thrombocytopenia)
• Severe skin reactions (rash, erythema, exantherma, and hives [urticaria])
• Pneumatosis cystoides intestinalis infection

• The recommended initial dose for type 2 diabetes 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.
• This medication should be taken at the first bite of each meal.
• Smaller doses may be adequate for patients with severe kidney dysfunction or liver disease.
• This medication is not recommended if a patient has cirrhosis.
• Precose therapy is not advised in the presence of certain medical conditions such as inflammatory bowel disease (IBD) or intestinal obstruction and chronic intestinal diseases that interfere with digestion or absorption such as Crohn's disease.
• The doses of this type 2 diabetes medication 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.)

• 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 treatment for hypoglycemia is with 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 administered. with this diabetes drug.

• There are no studies of acarbose treatment during pregnancy in humans. Insulin therapy is recommended in pregnancy.
• Acarbose is excreted in the milk of lactating animals, but no human studies have been conducted. Precose use is not recommended for women who are breastfeeding.

What preparations are available?

• Tablets: 25, 50 and 100 mg.

How should I keep this drug stored?

• Precose should be stored at room temperature, 15 C - 30 C (59 F - 86 F) in a tight container.

When was acarbose approved by the FDA?

• The FDA approved acarbose in September 1995.