Acarbose

Class
Hypoglycemic agents
Subclass
α-Glucosidase inhibitors
Substance name
Acarbose
Brand names
Precose®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Diabetes mellitus type 2
Weight ≤ 60 kg
•
Start at: 25 mg PO TID
•
Maintenance: 50 mg PO TID
•
Maximum: 150 mg per day
Titrate dose every 4-8 weeks based on response. Taken at the start of each meal.
Weight > 60 kg
•
Start at: 25 mg PO TID
•
Maintenance: 50-100 mg PO TID
•
Maximum: 300 mg per day
Titrate dose every 4-8 weeks based on response. Taken at the start of each meal.
Dumping syndrome • Off-label
•
50-100 mg PO TID
Titrate dose every 4-8 weeks based on response. Taken at the start of each meal.
Prediabetes • Off-label
•
Start at: 25 mg PO TID
•
Maintenance: 50-100 mg PO TID
Taken at the start of each meal.
Prevention
Prevention of postprandial hyperinsulinemic hypoglycemia, after gastric bypass surgery • Off-label
•
25-100 mg PO TID
Taken at the start of each meal.
Indications for use
Labeled indications
Adults
•
Treatment of diabetes mellitus type 2
Off-label indications
Adults
•
Treatment of dumping syndrome
•
Treatment of prediabetes
•
Prevention of postprandial hyperinsulinemic hypoglycemia, after gastric bypass surgery
Safety risks
Contraindications
Hypersensitivity to acarbose or its components
Chronic intestinal diseases
•
Do not use acarbose in patients with chronic intestinal diseases or conditions that may worsen as a result of increased intestinal gas formation.
Diabetic ketoacidosis
IBD, colonic ulceration, partial intestinal obstruction, or conditions predisposing to intestinal obstruction
Liver cirrhosis
Warnings and precautions
Decreased blood glucose
•
Use caution in patients taking other hypoglycemic medications.
Increased blood glucose
•
Use caution in patients being exposed to stress, including trauma, fever, infection, or surgery.
Increased serum transaminases
•
Maintain a high level of suspicion, as acarbose has been associated with an increased risk of elevated serum transaminases.
Specific populations
Renal impairment
eGFR ≥ 30 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR < 30 mL/min/1.73 m²
•
Do not use.
Renal replacement therapy
Any modality
•
Do not use.
Hepatic impairment
Any severity
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Consider safer alternatives. There are no adequate and well-controlled studies of acarbose during human pregnancy to determine a drug-associated risk of adverse developmental outcomes.
Breastfeeding
Little information available on breastfeeding safety.
•
Because < 2% of a dose of acarbose is absorbed from the mother's gastrointestinal tract, it is unlikely that any drug reaches the infant through breastmilk.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Abdominal pain, diarrhea, diarrhea, flatulence
Common 1-10%
•
↑ serum transaminases
Uncommon < 1%
•
Abdominal distension, ↓ blood glucose, ↓ hematocrit, ↓ platelet count, anemia, fulminant hepatic failure, gastrointestinal bleeding, ileus, bowel obstruction, intestinal perforation, jaundice, pneumoperitoneum, constipation, mucus in stools, rectal bleeding
Unknown frequency
•
Pneumatosis cystoides intestinalis, skin rash, urticaria, skin erythema
Interactions
Drug(s)
Check Interactions
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