II. Indications
- Type II Diabetes Mellitus
- Close to target (Hemoglobin A1C <8% as monotherapy)
III. Contraindications
- Creatinine Clearance <25 ml/min (or Serum Creatinine >2.0 mg/dl)
- Diabetic Ketoacidosis (DKA)
- Intestinal disorder
- Inflammatory Bowel Disease
- Colonic ulceration
- Small bowl obstruction history
- Partial Intestinal Obstruction
IV. Mechanism
- Structurally similar to Glucose
- Reversible inhibitor of the enzyme alpha glucosidase
- Present in brush border of Small Intestine
- Alpha glucosidase catalyzes complex Carbohydrates
- Interferes with hydrolysis of Carbohydrates
- Complex Carbohydrates
- Dietary Disaccharides
- Delays absorption of Glucose and other Monosaccharides
- Decreases postprandial Hyperglycemia
- Benefits rely on food within the Intestine at the time of medication dosing
V. Medications
- Miglitol (Glyset) tablets: 25 mg, 50 mg, 100 mg
VI. Dosing
- Start dose: 25 mg orally three times daily at start of meal
- May start with 25 mg orally daily if gastrointestinal side effects limit use
- Maintenance (after first 4 to 8 weeks)
- May increase to 50 mg orally three times daily
- Maximum: 100 mg three times daily
VII. Pharmacokinetics
- Miglitol is absorbed from Gastrointestinal Tract (unlike Acarbose)
- Not metabolized
- Excreted in urine
- Elimination Half-Life: 2 hours
- Excreted in Breast Milk in small amounts
VIII. Adverse Effects
- Poorly tolerated
- Decreased GI effects when taken with a high fiber, starchy diet
- Gastrointestinal side effects (unabsorbed Carbohydrate)
-
Hypoglycemia
- If used with other Oral Hypoglycemic agent or Insulin
- Use oral Glucose (not sucrose) to treat Hypoglycemia
IX. Safety
- Pregnancy Category B
- Avoid in Lactation
X. Drug Interactions
-
Insulin or Insulin Secretagogues (Sulfonylureas, Meglitinides)
- Consider decreasing their dosing when combined with Miglitol to reduce Hypoglycemia risk
XI. Resources
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A desoxynojirimycin derivative and inhibitor of alpha-glucosidase with antihyperglycemic activity. Miglitol binds to and inhibits alpha-glucosidase, an enteric enzyme found in the brush border of the small intestines that hydrolyzes oligosaccharides and disaccharides into glucose and other monosaccharides. This prevents the breakdown of larger carbohydrates into glucose and decreases the rise in postprandial blood glucose levels. Compared to acarbose, miglitol is systemically absorbed. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C045621 |
SnomedCT | 386046009, 109071007 |
English | miglitol, N-hydroxyethyl-1-desoxynojirimycin, N-hydroxyethyl-1-desoxy-nojirimycin, miglitol (medication), miglitol [Chemical/Ingredient], MIGLITOL, Miglitol (product), Miglitol (substance), Miglitol |
Spanish | miglitol (producto), miglitol (sustancia), miglitol |
Ontology: Glyset (C0720692)
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | C045621 |
English | Glyset, glyset |