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Miglitol

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Miglitol, Glyset

  • See Also
  1. Alpha-Glucosidase Inhibitor
  2. Oral Hypoglycemic Agents
  • Indications
  1. Type II Diabetes Mellitus
  2. Close to target (Hemoglobin A1C <8% as monotherapy)
  • Contraindications
  1. Creatinine Clearance <25 ml/min (or Serum Creatinine >2.0 mg/dl)
  2. Diabetic Ketoacidosis (DKA)
  3. Intestinal disorder
    1. Inflammatory Bowel Disease
    2. Colonic ulceration
    3. Small bowl obstruction history
    4. Partial Intestinal Obstruction
  • Mechanism
  1. Structurally similar to Glucose
  2. Reversible inhibitor of the enzyme alpha glucosidase
    1. Present in brush border of Small Intestine
    2. Alpha glucosidase catalyzes complex Carbohydrates
  3. Interferes with hydrolysis of Carbohydrates
    1. Complex Carbohydrates
    2. Dietary Disaccharides
  4. Delays absorption of Glucose and other Monosaccharides
    1. Decreases postprandial Hyperglycemia
    2. Benefits rely on food within the Intestine at the time of medication dosing
  • Medications
  1. Miglitol (Glyset) tablets: 25 mg, 50 mg, 100 mg
  • Dosing
  1. Start dose: 25 mg orally three times daily at start of meal
    1. May start with 25 mg orally daily if gastrointestinal side effects limit use
  2. Maintenance (after first 4 to 8 weeks)
    1. May increase to 50 mg orally three times daily
  3. Maximum: 100 mg three times daily
  • Pharmacokinetics
  1. Miglitol is absorbed from Gastrointestinal Tract (unlike Acarbose)
    1. Not metabolized
    2. Excreted in urine
    3. Elimination Half-Life: 2 hours
    4. Excreted in Breast Milk in small amounts
  • Adverse Effects
  1. Poorly tolerated
    1. Decreased GI effects when taken with a high fiber, starchy diet
  2. Gastrointestinal side effects (unabsorbed Carbohydrate)
    1. Abdominal Pain
    2. Abdominal Bloating
    3. Diarrhea
    4. Flatulence
  3. Hypoglycemia
    1. If used with other Oral Hypoglycemic agent or Insulin
    2. Use oral Glucose (not sucrose) to treat Hypoglycemia
  • Safety
  1. Pregnancy Category B
  2. Avoid in Lactation
  • Drug Interactions
  1. Insulin or Insulin Secretagogues (Sulfonylureas, Meglitinides)
    1. Consider decreasing their dosing when combined with Miglitol to reduce Hypoglycemia risk
  • Resources
  1. Miglitol (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b8da2015-d254-2425-e053-2995a90acf0e
  • References
  1. (1999) Med Lett Drugs Ther, 41(1053):49-50 [PubMed]
  2. Chiasson (1994) Ann Intern Med 121:928-35 [PubMed]
  3. Vaughan (2024) Am Fam Physician 109(4): 333-42 [PubMed]