Acarbose

Aka: Acarbose, Precose

advertisement

II. Indications

  1. Type II Diabetes Mellitus
  2. Close to target (Hemoglobin A1C <8% as monotherapy)

III. Contraindications

  1. Creatinine Clearance <25 ml/min (or Serum Creatinine >2.0 mg/dl)
  2. Diabetic Ketoacidosis (DKA)
  3. Cirrhosis (Acarbose specific)
  4. Intestinal disorder
    1. Inflammatory Bowel Disease
    2. Colonic ulceration
    3. Small bowl obstruction history
    4. Partial Intestinal Obstruction

IV. 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

V. Medications

  1. Acarbose (Precose) tablets: 25 mg, 50 mg, 100 mg

VI. 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 to 100 mg orally three times daily
  3. Maximum:
    1. Weight <60 kg: 50 mg three times daily
    2. Weight >60 kg: 100 mg three times daily

VII. Pharmacokinetics

  1. Acarbose is not absorbed from Gastrointestinal Tract (unlike Miglitol)

VIII. 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. Hepatotoxicity (Acarbose specific)
    1. Serum Transaminitis
  4. Hypoglycemia
    1. If used with other Oral Hypoglycemic agent or Insulin
    2. Use oral Glucose (not sucrose) to treat Hypoglycemia

IX. Safety

  1. Pregnancy Category B
  2. Avoid in Lactation

X. Efficacy

  1. Acarbose associated with cardiovascular benefits
    1. Reduced cardiovascular events
    2. Reduced Hypertension risk
    3. Significant weight loss
    4. Chiasson (2003) JAMA 290:486-94 [PubMed]

XI. Resources

  1. Acarbose (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=352dd336-d3f9-4ac5-a000-91d3aef7aca3

XII. 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]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Acarbose." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Cost: Medications

acarbose (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ACARBOSE 100 MG TABLET Generic $0.30 each
ACARBOSE 25 MG TABLET Generic $0.18 each
ACARBOSE 50 MG TABLET Generic $0.22 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

advertisement