What is acarbose, and how does it work?
- 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.
What are the uses 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.
What are the side effects of acarbose?
The most common side effects of include:
- 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
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What is the treatment dosage for acarbose?
- 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.)
QUESTION
______________ is another term for type 2 diabetes.
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Which drugs or supplements interact with acarbose?
- 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.
Is acarbose safe to use during pregnancy or while breastfeeding?
- 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 else should I know about acarbose?
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.