- Type II Diabetes Mellitus
- Close to target (Hemoglobin A1C <8% as monotherapy)
- Creatinine Clearance <25 ml/min (or Serum Creatinine >2.0 mg/dl)
- Diabetic Ketoacidosis (DKA)
- Cirrhosis (Acarbose specific)
- Intestinal disorder
- Inflammatory Bowel Disease
- Colonic ulceration
- Small bowl obstruction history
- Partial Intestinal Obstruction
- Structurally similar to Glucose
- Reversible inhibitor of the enzyme alpha glucosidase
- Present in brush border of Small Intestine
- Alpha glucosidase catalyzes complex Carbohydrates
- Interferes with hydrolysis of Carbohydrates
- Complex Carbohydrates
- Dietary Disaccharides
- Delays absorption of Glucose and other Monosaccharides
- Decreases postprandial Hyperglycemia
- Benefits rely on food within the Intestine at the time of medication dosing
- Acarbose (Precose) tablets: 25 mg, 50 mg, 100 mg
- Start dose: 25 mg orally three times daily at start of meal
- May start with 25 mg orally daily if gastrointestinal side effects limit use
- Maintenance (after first 4 to 8 weeks)
- May increase to 50 to 100 mg orally three times daily
- Maximum:
- Weight <60 kg: 50 mg three times daily
- Weight >60 kg: 100 mg three times daily
- Acarbose is not absorbed from Gastrointestinal Tract (unlike Miglitol)
- Poorly tolerated
- Decreased GI effects when taken with a high fiber, starchy diet
- Gastrointestinal side effects (unabsorbed Carbohydrate)
- Hepatotoxicity (Acarbose specific)
- Serum Transaminitis
-
Hypoglycemia
- If used with other Oral Hypoglycemic agent or Insulin
- Use oral Glucose (not sucrose) to treat Hypoglycemia
- Pregnancy Category B
- Avoid in Lactation
- Acarbose associated with cardiovascular benefits
- Reduced cardiovascular events
- Reduced Hypertension risk
- Significant weight loss
- Chiasson (2003) JAMA 290:486-94 [PubMed]