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alpha glucosidase inhibitors
Management of type 2 diabetes in conjunction with dietary therapy; may be used with insulin or other hypoglycemic agents.
Lowers blood glucose by inhibiting the enzyme alpha-glucosidase in the GI tract. Delays and reduces glucose absorption.
Lowering of blood glucose in diabetic patients, especially postprandial hyperglycemia.
Absorption: <2% systemically absorbed; action is primarily local (in the GI tract).
Metabolism and Excretion: Minimal amounts absorbed are excreted by the kidneys.
Half-life: 2 hr.
TIME/ACTION PROFILE (effect on blood glucose)
- Diabetic ketoacidosis
- Serum creatinine >2 mg/dL
- OB: Lactation: Pedi: Safety not established.
Use Cautiously in:
Presence of fever, infection, trauma, stress (may cause hyperglycemia, requiring alternative therapy).
Adverse Reactions/Side Effects
GI: abdominal pain, diarrhea, flatulence, ↑ transaminases
* CAPITALS indicate life-threatening.
Italics indicate most frequent.
- Thiazide diuretics and loop diuretics, corticosteroids, phenothiazines, thyroid preparations, estrogens (conjugated), progestins, hormonal contraceptives, phenytoin, niacin, sympathomimetics, calcium channel blockers, and isoniazid may ↑ glucose levels in diabetic patients and lead to ↓ control of blood glucose.
- Effects are↓ by intestinal adsorbents, including activated charcoal and digestive enzyme preparations (amylase, pancreatin); avoid concurrent use.
- May ↓ absorption of digoxin; may require dosage adjustment.
- Glucosamine may worsen blood glucose control.
- Chromium and coenzyme Q-10 may ↑ hypoglycemic effects.
PO: (Adults) 25 mg 3 times daily; may be increased q 4–8 wk as needed/tolerated (range 50–100 mg 3 times daily; not to exceed 50 mg 3 times daily in patients ≤60 kg or 100 mg 3 times daily in patients >60 kg).
Availability (generic available)
Tablets: 25 mg, 50 mg, 100 mg
Observe patient for signs and symptoms of hypoglycemia (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety) when taking concurrently with other oral hypoglycemic agents.
Lab Test Considerations:
Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness.
- Monitor AST and ALT every 3 mo for the 1st yr and then periodically. Elevated levels may require dose reduction or discontinuation of acarbose. Elevations occur more commonly in patients taking more than 300 mg/day and in female patients. Levels usually return to normal without other evidence of liver injury after discontinuation.
Symptoms of overdose are transient increase in flatulence, diarrhea, and abdominal discomfort. Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia requiring treatment.
- Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
- Does not cause hypoglycemia when taken while fasting, but may increase hypoglycemic effect of other hypoglycemic agents.
- PO: Administer with first bite of each meal 3 times/day.
- Instruct patient to take acarbose at same time each day. If a dose is missed and the meal is completed without taking the dose, skip missed dose and take next dose with the next meal. Do not double doses.
- Explain to patient that acarbose controls hyperglycemia but does not cure diabetes. Therapy is longterm.
- Review signs of hypoglycemia and hyperglycemia (blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination; ketones in urine; loss of appetite; stomachache; nausea or vomiting; tiredness; rapid, deep breathing; unusual thirst; unconsciousness) with patient. If hypoglycemia occurs, advise patient to take a form of oral glucose (e.g., glucose tablets, liquid gel glucose) rather than sugar (absorption of sugar is blocked by acarbose) and notify health care professional.
- Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
- Instruct patient in proper testing of serum glucose and urine ketones. Monitor closely during periods of stress or illness. Notify health care professional if significant changes occur.
- Caution patient to avoid using other medications without consulting health care professional.
- Advise patient to inform health care professional of medication regimen before treatment or surgery.
- Advise patient to carry a form of oral glucose and identification describing disease process and medication regimen at all times.
- Emphasize the importance of routine follow-up examinations.
Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.