Acarbose

Indications

Acarbose is used for: Type 2 DM

Adult Dose

Dosage Adult: PO Initial: 25 mg/day q8hr. May adjust gradually. Maintenance: 50-100 mg 3 times/day. Max: <60 kg: 50 mg 3 times/day. >60 kg: 100 mg 3 times/day. Hepatic Impairment Severe: Contraindicated.

Child Dose

Renal Dose

Renal Impairment CrCl Dosage <25 Contraindicated.

Administration

Should be taken with food. Take w/ 1st bite of each main meal.

Contra Indications

Patients <18 yr; diabetic ketoacidosis or cirrhosis; malabsorption; inflammatory bowel disease; with or pre-disposed to intestinal obstruction; intestinal diseases that affect digestion or absorption; conditions that worsen as a result of increased gas formation e.g. hernias; colonic ulcers; hepatic impairment; CrClr< 25 ml/min/1.73m2. Pregnancy, lactation.

Precautions

Monitor LFT every 3 mth for 1st yr and periodically thereafter especially for doses >50 mg tid. Reduce dose or withdraw therapy if transaminases elevations persist. If hypoglycaemia occurs, give glucose orally as a 1st aid measure. Adhere strictly to the prescribed diabetic diet to avoid intensification of GI symptoms. Lactation: not known if crosses into breast milk, avoid using in nursing women.

Pregnancy-Lactation

Pregnancy Category: B Lactation: not known if crosses into breast milk, avoid using in nursing women

Interactions

May enhance effects of other antidiabetics including insulin. Diminished effects w/ GI adsorbents (e.g. charcoal) and digestive enzyme preparations containing carbohydrate splitting enzymes (e.g. amylase, pancreatin). Neomycin and colestyramine may enhance effects of acarbose. May inhibit absorption of digoxin.

Adverse Effects

Side effects of Acarbose : >10% abdominal pain (19%), diarrhea (31%), elevated serum transaminases, flatulence (74%) Potentially Fatal: Hepatotoxicity.

Mechanism of Action

Acarbose competitively and reversibly inhibits pancreatic alpha-amylase and intestinal brush border alpha-glucosidases, resulting in retardation of glucose absorption from hydrolysed complex carbohydrates and reduction of blood-glucose concentrations.