II. Indications

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

III. Contraindications

  1. Diabetic Ketoacidosis (DKA)
  2. Intestinal disorder
    1. Inflammatory Bowel Disease
    2. Colonic ulceration
    3. Partial Intestinal Obstruction

IV. Mechanism

  1. Structurally similar to Glucose
  2. Reversible inhibitor of alpha glucosidase
    1. Present in brush border of Small Intestine
  3. Interferes with hydrolysis of Carbohydrates
    1. Complex Carbohydrates
    2. Dietary Disaccharides
  4. Delays absorption of Glucose and other Monosaccharides

V. 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

VI. Adverse Effects

  1. Poorly tolerated
  2. Gastrointestinal side effects (unabsorbed Carbohydrate)
    1. Abdominal Pain
    2. Diarrhea
    3. Flatulence
  3. Hypoglycemia
    1. If used with other Oral Hypoglycemic agent or Insulin
    2. Use oral Glucose (not sucrose) to treat Hypoglycemia

VII. 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]

VIII. Dosages

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

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Related Studies

Cost: Medications

acarbose (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ACARBOSE 100 MG TABLET Generic $0.25 each
ACARBOSE 25 MG TABLET Generic $0.20 each
ACARBOSE 50 MG TABLET Generic $0.23 each
glyset (on 6/1/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
GLYSET 100 MG TABLET $3.16 each
GLYSET 25 MG TABLET $2.48 each
GLYSET 50 MG TABLET $2.70 each