acarbose

General

Pronunciation
aye-KAR-bose [Pronunciation]

Trade Name(s)

• Precose

Pregnancy Category
Category B

Ther. class.
antidiabetics

Pharm. class.
alpha glucosidase inhibitors

Indications

Management of type 2 diabetes in conjunction with dietary therapy; may be used with insulin or other hypoglycemic agents.

Action

Lowers blood glucose by inhibiting the enzyme alpha-glucosidase in the GI tract. Delays and reduces glucose absorption.

Therapeutic Effect(s):
Lowering of blood glucose in diabetic patients, especially postprandial hyperglycemia.

Pharmacokinetics

Absorption: <2% systemically absorbed; action is primarily local (in the GI tract).

Distribution: Unknown.

Metabolism and Excretion: Minimal amounts absorbed are excreted by the kidneys.

Half-life: 2 hr.

TIME/ACTION PROFILE (effect on blood glucose)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	1 hr	unknown

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity;

• Diabetic ketoacidosis;

• Cirrhosis;

• 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 indicates life-threatening.
*italic indicates most frequent.

Interactions

Drug-Drug

• 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.

• ↑ effects of sulfonylurea hypoglycemic agents .

• May ↓ absorption of digoxin ; may require dosage adjustment.

Drug-Natural Products

• Glucosamine may worsen blood glucose control.

• Chromium and coenzyme Q-10 may ↑ hypoglycemic effects.

Route/Dosage

• 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

• Tablets: 25 mg, 50 mg, 100 mg

Assessment

• 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.

Toxicity and Overdose

• 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.

Potential Nursing Diagnoses

• Imbalanced nutrition: more than body requirements (Indications)

• Noncompliance (Patient/Family Teaching)

Implementation

• 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.

Patient/Family Teaching

• 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.

Evaluation/Desired Outcomes

Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.