II. Indications
- Type II Diabetes Mellitus
- Close to target (Hemoglobin A1C <8% as monotherapy)
III. Contraindications
- Diabetic Ketoacidosis (DKA)
- Intestinal disorder
- Inflammatory Bowel Disease
- Colonic ulceration
- Partial Intestinal Obstruction
IV. Mechanism
- Structurally similar to Glucose
- Reversible inhibitor of alpha glucosidase
- Present in brush border of Small Intestine
- Interferes with hydrolysis of Carbohydrates
- Complex Carbohydrates
- Dietary Disaccharides
- Delays absorption of Glucose and other Monosaccharides
V. Pharmacokinetics
- Acarbose is not absorbed from Gastrointestinal Tract
- Miglitol is absorbed from Gastrointestinal Tract
- Not metabolized
- Excreted in urine
- Elimination Half-Life: 2 hours
- Excreted in Breast Milk in small amounts
VI. Adverse Effects
- Poorly tolerated
- Gastrointestinal side effects (unabsorbed Carbohydrate)
-
Hypoglycemia
- If used with other Oral Hypoglycemic agent or Insulin
- Use oral Glucose (not sucrose) to treat Hypoglycemia
VII. Efficacy
- Acarbose associated with cardiovascular benefits
- Reduced cardiovascular events
- Reduced Hypertension risk
- Significant weight loss
- Chiasson (2003) JAMA 290:486-94 [PubMed]
VIII. Dosages
- Acarbose (Precose)
- Start dose: 25 mg PO tid at start of meal
- Maintenance: 50-100 mg PO tid ($45/month)
- Miglitol (Glyset)
- Start dose: 25 mg PO tid at start of meal
- Maintenance: 50-100 mg PO tid ($52/month)
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Related Studies
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 |