Acarbose (Oral)

Acarbose is an oral antidiabetic medication used to treat type 2 diabetes that blocks alpha-glucosidase enzymes in the small intestines and pancreatic alpha-amylase which reduces blood glucose levels.

Overview

Acarbose is an oral prescription drug used to treat type 2 diabetes. It belongs to a class of drugs known as alpha-glucosidase inhibitors. Acarbose treats type 2 diabetes by controlling the increase in blood sugar levels by preventing the conversion of starch into sugar. It is designed to be used in conjunction with a healthy diet and exercise. Acarbose is effective because it blocks the enzymes that are needed to digest carbohydrates. In particular, it blocks alpha-glucosidase enzymes in the small intestines and pancreatic alpha-amylase. Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the small intestine. The membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides until they create glucose and other monosaccharides in the small intestine, preventing carbohydrates from breaking down into glucose and decreasing the absorption of glucose. Through this process, blood glucose levels can be reduced and managed. Over time, this process can help to reduce HbA1c levels, resulting in a 10% decrease in HbA1c values. These results have been proven through clinical diabetes studies. Adjustments are often made to how much Acarbose a patient takes as well as other drugs a patient may be taking that may have an impact on the effects of Acarbose.

Conditions Treated

Type of Medication

  • Therapeutic antidiabetic medication
  • Pharmacologic alpha-glucosidase inhibitor.

Side Effects

Common side effects of Acarbose include:

  • Abdominal pain
  • Diarrhea
  • Gas
  • An increase in liver enzymes

Other common side effects include:

  • Severe stomach pain
  • Severe constipation
  • Diarrhea (watery or bloody)
  • Easy bruising
  • Unusual bleeding (nose, mouth, vagina, or rectum)
  • Purple or red pinpoint spots under your skin
  • Nausea
  • Upper stomach pain
  • Itching
  • Loss of appetite
  • Dark urine
  • Clay-colored stools
  • Jaundice

However, in rare occurrences, some of the side effects can be serious. One of the more serious gastrointestinal side effects of Acarbose is paralysis of the intestinal muscles, resulting in an intestinal obstruction. Other serious side effects include:

  • Decreases in hematocrit and calcium
  • Decreases in vitamin B6 levels
  • Liver failure
  • Jaundice
  • Hepatitis
  • Ileus
  • Decrease in platelets
  • Severe skin reactions: rash, erythema, exanthema, and hives urticaria
  • Pneumatosis cystoids intestinal infection

Dosage

The recommended dosage for Acarbose is two 25mg pills taken three times a day. The dose is then increased every 1 to 2 months based on the body's response and tolerance level. The max dose is 50mg for people weighing 132 pounds or less. Those that weigh more than 132 pounds can receive a max dose of 100mg. The max dose is supposed to be taken three times a day. Adjustments to this drug should be made based on blood glucose levels taken an hour after a meal. Blood HbA1c levels should be checked three months after Acarbose dosing has started or been adjusted.

This anti-diabetic drug comes in 25, 50 and 100 mg concentrations and is taken in pill form, with or without other sulfonylureas like glyburide (Diabeta) or metformin (Glucophage). It can even be taken with insulin. Acarbose was FDA approved in September of 1995 and requires a prescription for use. It is available in generic form under the drug name Precose; however, it is sold under other names too:

  • Acarbose
  • Precose
  • Acarbosum
  • Glucobay
  • AC1L9APL
  • Prandase

Acarbose should be taken at the beginning of each meal and can be reduced for people with kidney dysfunction or liver disease. However, it should be noted that Acarbose is not recommended for those that suffer from cirrhosis, inflammatory bowel disease (IBD) or intestinal obstruction. In fact, anyone with a chronic intestinal disease that interferes with digestion or absorption, such as Crohn's disease, should not take Acarbose.

If you miss a dose take one as soon as possible, preferably with the first bite of a meal. If you forget to take it at the beginning of your meal, you can still take it while eating, however, it may not be as effective. Acarbose should never be taken between meals and extra medication should never be taken to make up for a missed dose.

Little is known regarding the effects of Acarbose and pregnancy. There have been no human studies conducted. Acarbose is not believed to be a threat to an unborn baby, however, studies conducted on animals have revealed that Acarbose is excreted in the milk of lactating animals. The effects of Acarbose in breast milk have not been studied for efficacy in humans. As a result, insulin therapy is suggested for lactating women who plan on breastfeeding. Insulin therapy is recommended for use in breastfeeding women.

There have been no studies conducted on children in terms of the effects of Acarbose. However, there have been limited studies conducted on older adults and no significant side effects were found in comparison to younger recipients.

Interactions

Acarbose can hinder digoxin absorption, causing a drop in digoxin blood levels. As a result, the digoxin dose may need to be increased once Acarbose dosing has begun. It should also be noted that beta blockers may make it difficult to recognize symptoms of low blood sugar due to the fact that they prevent the pounding heartbeat you usually experience when your blood sugar falls too low. Examples of beta blockers include metoprolol, propranolol, com/health/coma/">glaucoma eye drops (timolol).

Green Tea: (Moderate) Green tea catechins decrease serum glucose concentrations. Closely monitor anyone taking Acarbose for symptoms of hypoglycemia if they are consuming green tea products.

Acetaminophen: Animal studies suggest that Acarbose increases the metabolism of acetaminophen to a toxic reactive metabolite. Patients should avoid the combination of Acarbose with acetaminophen and ethanol.

Acetaminophen; Aspirin, ASA; Caffeine: These indirectly increase insulin secretion, decrease blood sugar and can cause hyperglycemia. Large doses of aspirin should be avoided in patients receiving antidiabetic agents.

Acetaminophen; Butalbital: Acarbose increases the activity of the hepatic isoenzyme to a toxic reactive metabolite.

Chromium: Chromium dietary supplements lower blood sugar levels. Blood sugar could be affected by the use of chromium and adjustments may need to be made.

Ciclesonide: Corticosteroids increase blood sugar levels. Patients who are on corticosteroid therapy may have to make adjustments to their Acarbose dosage.

Ciprofloxacin: Changes in blood glucose levels, including hyperglycemia and hypoglycemia, are not uncommon in patients who are also taking an antidiabetic medicine.

Cisapride: Cisapride can increases gas in patients with diabetes. Blood sugar levels can be affected as well. As a result, dosages may require adjusting in some patients.

Clarithromycin: Clarithromycin could increase the hypoglycemic effects of antidiabetic medicines like Acarbose.

Clonidine: Clonidine could affect the hypoglycemic effects of antidiabetic medicines like Acarbose. This drug may also cover up the signs of hypoglycemia.

Codeine; Phenylephrine; Promethazine: Phenothiazines increase blood sugar levels. As a result, patients should monitor their blood sugar levels closely.

Tobacco: Nicotine activates neuroendocrine pathways and can increase blood glucose levels as well as aggravate insulin resistance. As a result, it's a good idea to monitor blood sugar levels closely.

Trandolapril: (Moderate) ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Patients receiving antidiabetic agents can become hypoglycemic if ACE inhibitors are administered concomitantly. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.

Trandolapril; Verapamil: (Moderate) ACE inhibitors may enhance the hypoglycemic effects of insulin or other antidiabetic agents by improving insulin sensitivity. Patients receiving antidiabetic agents can become hypoglycemic if ACE inhibitors are administered concomitantly. Patients receiving these drugs concomitantly with antidiabetic agents should be monitored for changes in glycemic control.

Tranylcypromine: Animal data indicate that monoamine oxidase inhibitors (MAO inhibitors) may stimulate insulin secretion. Inhibitors of MAO type A have been shown to prolong the hypoglycemic response to insulin and oral sulfonylureas. Serum glucose should be monitored closely when MAOI-type medications, including the selective MAO-B inhibitor selegiline, are added to any regimen containing antidiabetic agents. Although at low doses selegiline is selective for MAO type B, in doses above 30 to 40 mg/day, this selectivity is lost.

Thyroid hormones: Thyroid hormones may result in a need to increase the dosage requirements of antidiabetic drugs. Monitor blood sugar levels closely when taking thyroid hormones.

Timolol: This Beta-blocker could cause a negative interaction with antidiabetic drugs and result in a prolonged hypoglycemic state. Also, beta-blockers can mute many of the physiologic symptoms of hypoglycemia. Diabetic patients who are also taking beta-blockers need to closely monitor their blood sugar levels.

Niacin, Niacinamide: Niacin interacts negatively with glucose metabolism. This can create the onset of hyperglycemia. However, this can be corrected through hypoglycemic therapy. Nevertheless, antidiabetic medicines may require dosing adjustments.

Niacin; Simvastatin: Niacin hinders glucose metabolism and can result in hyperglycemia. As a result, hypoglycemic therapy may need to be modified. Antidiabetic Dosage adjustments may be necessary.

Nicotine: Nicotine may boost blood sugar levels and hinder insulin resistance. As a result, blood glucose levels should be monitored closely. You may need to make adjustments to your antidiabetic medicine.

Magnesium Salicylate: Salicylates indirectly increases insulin secretion and can decrease blood sugar. In large doses, salicylates can cause hyperglycemia and glycosuria.

Mecasermin Rinfabate: Mecasermin and antidiabetic medicines can create a hypoglycemic effect. Eat within 20 minutes of taking mecasermin. In addition, monitor blood sugar levels closely when taking these two drugs.

Mecasermin, Recombinant, rh-IGF-1: Mecasermin and antidiabetic drugs can have a hypoglycemic effect on the body. It's important to monitor blood sugar levels when taking mecasermin.

Warnings

Caution should be exercised when combining Acarbose with other drugs. The likelihood of developing Hypoglycemia is increased when both insulin or a sulfonylurea are combined with Acarbose therapy. If the combination of these drugs results in a middle case of hypoglycemia oral glucose (dextrose) should be given as treatment. Acarbose, as well as other antidiabetic drugs, do not create a predisposition to hypoglycemia. This predisposition is created when these anti-diabetic drugs are combined. In addition, it should also be noted that charcoal absorbs Acarbose rendering it ineffective, just as digestive enzymes amylase and pancreatin break down Acarbose and should not be taken in conjunction with Acarbose. Do not take Acarbose with alcohol. Furthermore, Acarbose is not recommended for anyone who is in a state of diabetic ketoacidosis, insulin treatments should be used instead. Avoid taking Acarbose with drugs that raise your blood sugar:

  • Isoniazid
  • Digoxin (Lanoxin)
  • Niacin (Advicor, Niaspan, Niacor, Simcor, Slo Niacin)
  • Nicotine patches or gum- Diuretics
  • Steroids (Prednisone)
  • Phenothiazines (Compazine)
  • Thyroid medicine (Synthroid)
  • Birth control pills
  • Cold and asthma medicine
  • Seizure medications (Dilantin)
  • Diet pills, stimulants, or medicines to treat ADHD; or
  • Heart or blood pressure medicine such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), diltiazem (Cartia, Cardizem), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others.

Avoid drinking alcohol with Acarbose, it will result in severe low blood sugar. In addition, do not take aspirin, cough, sinus, and cold medicines with Acarbose. It's not uncommon for family members to need counseling to become familiar with the side effects of Acarbose as a source of support. If you travel, keep your prescription and medical history with you and in the event of a low sugar episode, eat glucose tablets, gel, honey, or drink fruit juice to relieve the symptoms. In extreme emergency situations, Glucagon is used when seizures or unconsciousness occurs. As a result, it's a good idea to keep a glucagon kit with a syringe and needle.

In rare situations, Acarbose can cause serious reactions that affect the intestines. One such condition is called Pneumatosis cystoids intestinalis. This condition is characterized by gas-filled cysts on the wall of your intestines. Other adverse reactions include skin allergies, rashes, and even liver damage. Often the symptoms manifest in the form of swelling, redness, hives, itching, rash, fever, trouble breathing, chest tightness, blistering skin, swelling of the mouth, face, lips, tongue, or throat.

Storage

Acarbose should be kept at room temperature, 15 C - 30 C (59 F - 86 F) in an airtight container. It should be kept away from extreme heat and moisture.

Summary

Acarbose is a prescription medication used to treat type 2 diabetes. It is available in generic form and is sold under a variety of different names. Acarbose goes to work in the intestines decreasing the breakdown of starches and carbohydrates in order to prevent your blood sugar from rising after a meal. Acarbose is taken orally three times a day at the onset of a meal. Your doctor determines your dosage by your medical condition and response to the treatment. Although this anti-diabetic medication doesn't cause low blood sugar, this condition can occur if other anti-diabetic drugs are taken along with Acarbose. However, low blood sugar can also arise from not eating enough and overexerting yourself with exercise. Acarbose is generally taken progressively. The dosage is increased until a max level is reached. During this process, a doctor reviews the effects of the medication to determine how much to give and how long you should take it. Because Acarbose has many interactions with a wide variety of prescription and OTC drugs it is recommended that anyone taking Acarbose fully disclose all the other medications they are taking as well. Even green tea has been noted for its interactions with Acarbose. Fully disclose any and all drugs, supplements, and herbs that you may be taking to ensure that none of them will have harmful interactions with Acarbose.

Resources
Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018
Content Source: