Acarbose information from DrugsUpdate
P - Contraindicated in pregnancy
L - Contraindicated in lactation
Acarbose is an anti-diabetic drug used to treat type 2 diabetes mellitus and, in some countries, prediabetes. It is an inhibitor of alpha glucosidase, an enteric enzyme that releases glucose from larger carbohydrates.
Pharmacodynamics
Pharmacokinetics
Acarbose competitively and reversibly inhibits pancreatic α-amylase and intestinal brush border α-glucosidases, resulting in retardation of glucose absorption from hydrolysed complex carbohydrates and reduction of blood-glucose concentrations.
Absorption
35% absorbed from the GI tract (oral).
Metabolism
Intestines by microbial flora and intestinal enzymes.
Excretion
Via urine and faeces.
Acarbose Indications / Acarbose Uses
Information Not Available
Acarbose Adverse Reactions / Acarbose Side Effects
Flatulence, abdominal pain, distension, diarrhoea, nausea, vomiting. Elevation of transaminases, hepatitis, jaundice. Rarely, skin reactions.
Potentially Fatal: Hepatotoxicity.
Precautions
Enquire if the patient has: iron deficiency, kidney disease, liver disease, stomach/digestive or intestinal disorders, any allergies. During times of stress such as fever, infection, injury or surgery, it may be more difficult to control blood sugar. Because Acarbose prevents the breakdown of table sugar, patients should have a readily available source of glucose (such as glucose tablets) to treat symptoms of low blood sugar if taking acarbose in combination with other medications to treat diabetes.
Special Precautions
Monitor LFT every 3 months for 1st year and periodically thereafter especially for doses >50 mg tid. Reduce dose or withdraw therapy if transaminases elevations persist. If hypoglycaemia occurs, give glucose orally as a 1st aid measure. Adhere strictly to the prescribed diabetic diet to avoid intensification of GI symptoms.
Other Drug Interactions
Drugs that may increase blood glucose levels e.g. thiazides, steroids, chlorpromazine, atypical antipsychotics, may antagonise the action of acarbose. GI adsorbents and digestive enzyme preparations may reduce acarbose effects; avoid concomitant admin. Cholestyramine may enhance effects of acarbose. Effects of other hypoglycaemics may be potentiated by acarbose. Neomycin may enhance reduction of postprandial blood-glucose and intensify GI symptoms. Acarbose may reduce digoxin bioavailability. May interact with warfarin and affect INR. Increased risk of hypoglycaemia with disopyramide.
Other Interactions
Information Not Available
Dosage
Oral
Type 2 diabetes mellitus
Adult: Initially, 25 mg daily. May adjust dose at 4-8 wkly intervals based on tolerance and 1-hour post-prandial blood glucose levels. Maintenance dose: 50-100 mg tid. Max: ≤60 kg: 50 mg tid; >60 kg: 100 mg tid.
CrCl (ml/min) Dosage Recommendation
<25 Contraindicated
Food(before/after)
Should be administered with the first bite of each main meal.
List of Contraindications
Acarbose and Pregnancy
Contraindicated in pregnancy
Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).
Acarbose and Lactation
Contraindicated in lactation
Acarbose and Children
Acarbose should not be used in children
Acarbose and Geriatic
Information Not Available
Acarbose and Other Contraindications
Patients <18 years; diabetic ketoacidosis or cirrhosis; malabsorption; inflammatory bowel disease; with or pre-disposed to intestinal obstruction; intestinal diseases that affect digestion or absorption; conditions that worsen as a result of increased gas formation e.g. hernias; colonic ulcers; hepatic impairment; CrClr< 25 ml/min/1.73m2. Pregnancy, lactation.
Storage
Oral
Store below 25°C.
Lab interference
Oral
Store below 25°C.
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