Alpha-glucosidase Inhibitor

Aka: Alpha-glucosidase Inhibitor, Acarbose, Precose, Miglitol, Glyset

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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)
  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. Dosing

  1. Acarbose (Precose)
    1. Start dose: 25 mg orally three times daily at start of meal
    2. Maintenance: 50-100 mg orally three times daily ($45/month)
  2. Miglitol (Glyset)
    1. Start dose: 25 mg orally three times daily at start of meal
    2. Maintenance: 50-100 mg orally three times daily ($52/month)

VI. Pharmacokinetics

  1. Acarbose is not absorbed from Gastrointestinal Tract
  2. Miglitol is absorbed from Gastrointestinal Tract
    1. Not metabolized
    2. Excreted in urine
    3. Elimination Half-Life: 2 hours
    4. Excreted in Breast Milk in small amounts

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

VIII. 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]

IX. 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]

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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

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