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acarbose (Precose)
Tradename: Precose.
Indications:
1) type 2 diabetes with poor glycemic control (HgbA1c > 8.5%)
2) especially for use in type II diabetics with post-prandial hyperglycemia
3) may be useful as monotherapy
4) useful as adjunctive agent to sulfonylurea
5) may be useful in patients who fail sulfonylurea therapy & in whom metformin is contraindicated
Contraindications:
1) diabetic ketoacidosis (DKA)
2) hepatic cirrhosis
3) inflammatory bowel disease
4) colonic ulceration
5) partial intestinal obstruction
6) chronic intestinal disease associated with marked disorder of digestion or absorption
7) a condition that deteriorate as a result of increased gas formation within the intestine Cautions:
-> avoid using in patients with serum creatinine > 2.0 mg/dL
Dosage:
1) start: 25 mg PO TID (25 mg QD [4])
2) max: 100 mg PO TID (> 60 kg); 50 mg TID (< 60 kg)
3) with first bite
4) discontinue if not effective at max dose for 3 months
Tabs: 50 & 100 mg.
Pharmacokinetics:
1) not absorbed
2) may decrease fasting blood sugar by 20 mg/dL
3) may decrease 2 hours post-prandial blood sugar by 40 mg/dL
4) may decrease HgbA1c by 0.8% or more
Monitor:
1) post-prandial glucose
2) hemoglobin A1c (HgbA1c)
3) serum transaminases every 3 months for 1st year, then periodically thereafter [7]
Adverse effects:
1) GI effects (30-60%) related to undigested sugars reaching the colon - does NOT interfere with lactase
a) flatulence
b) bloating & diarrhea
c) reduce intake of carbohydrate to minimize GI side effects
2) common (> 10%)
a) may elevate liver enzymes at highest doses
b) abdominal pain
3) uncommon (< 1%)
- sleepiness, weakness, headache, vertigo, erythema, urticaria, severe gastrointestinal distress
Give glucose rather than sucrose, fructose etc. for hypoglycemia
Drug interactions:
- additive effects with sulfonylureas on plasma glucose
Mechanism of action:
1) carbohydrate analog
2) inhibits alpha glucosidase
3) slows digestion of complex carbohydrates
4) major effect is on post-prandial hyperglycemia
Interactions
drug interactions
drug adverse effects of hypoglycemic agents
General
alpha glucosidase inhibitor
Properties
INHIBITS: maltase
MISC-INFO: elimination route FECES
pregnancy-category B
safety in lactation -
Database Correlations
PUBCHEM correlations
References
- Bayer Corporation
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Prescriber's Letter 9(8):45 2002
- Prescriber's Letter 10(9):51 2003
- Caiasson J-L et al, JAMA 390:486, 2003
- Department of Veterans Affairs, VA National Formulary
- non formulary drug request
- Prescriber's Letter 17(7): 2010
Recommended Lab Monitoring for Common Medications
Detail-Document#: 260704
(subscription needed) http://www.prescribersletter.com