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