Acarbose

Indications
Oral
Type 2 diabetes mellitus
Adult: Initially, 25 mg daily. May adjust dose at 4-8 wkly intervals based on tolerance and 1-hr post-prandial blood glucose levels. Maintenance dose: 50-100 mg tid. Max: ≤60 kg: 50 mg tid; >60 kg: 100 mg tid.
CrCl (ml/min)Dosage Recommendation
<25Contra-indicated.
Contraindications
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.
Warnings / 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.
Adverse Reactions
Flatulence, abdominal pain, distension, diarrhoea, nausea, vomiting. Elevation of transaminases, hepatitis, jaundice. Rarely, skin reactions.
Potentially Fatal: Hepatotoxicity.
Overdose Reactions
Symptoms: Transient increases in flatulence, diarrhoea and abdominal discomfort. Management: Patient should not be given drinks or meals containing carbohydrates for the next 4-6 hr.
Drug Interactions
Drugs that may increase blood glucose levels e.g. thiazides, steroids, chlorpromazine, atypical antipsychotics, may antagonise the action of acarbose. GI adsorbents and digestive enzyme preparations may reduce acarbose effects; avoid concomitant admin. Cholestyramine may enhance effects of acarbose. Effects of other hypoglycaemics may be potentiated by acarbose. Neomycin may enhance reduction of postprandial blood-glucose and intensify GI symptoms. Acarbose may reduce digoxin bioavailability. May interact with warfarin and affect INR. Increased risk of hypoglycaemia with disopyramide.
See Below for More acarbose Drug Interactions
Mechanism of Actions
Acarbose competitively and reversibly inhibits pancreatic α-amylase and intestinal brush border α-glucosidases, resulting in retardation of glucose absorption from hydrolysed complex carbohydrates and reduction of blood-glucose concentrations.
Absorption: 35% absorbed from the GI tract (oral).
Metabolism: Intestines by microbial flora and intestinal enzymes.
Excretion: Via urine and faeces.
Administration
Should be taken with food. (Take w/ 1st bite of each main meal.)
Storage Conditions
Oral: Store below 25°C.
ATC Classification
A10BF01 - acarbose ; Belongs to the class of alpha glucosidase inhibitors. Used in the treatment of diabetes.
Storage
Oral: Store below 25°C.
Available As
  • Acarbose 100 mg
  • Acarbose 25 mg
  • Acarbose 50 mg
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