Acarbose

Brand names

• Prandase
• Precose

Usage

As an adjunct (supplemental) therapy in patients with diabetes who do not require insulin injections yet are unable to control their blood glucose levels with diet alone or with other medications.

How it works

Acarbose inhibits the activity of enzymes required to break carbohydrates down into simple sugars within the intestine. This effect delays the digestion of carbohydrates and thus reduces the rise in blood sugar that typically occurs after meals.

Side effects

Serious

There are no serious side effects associated with acarbose.

Common

Feelings of bloating, gas, abdominal discomfort, diarrhea. These symptoms tend to decrease over time.

Less common

Rise in liver enzymes, causing yellowish tinge to eyes or skin (jaundice), when maximal dose is exceeded. When used in combination with sulfonylureas, may cause symptoms of low blood sugar, which include sweating, tremor, anxiety, hunger, confusion, seizures, rapid heartbeat, vision changes, dizziness, headache, loss of consciousness. Hypoglycemia must be treated by ingestion of glucose (dextrose). Sucrose (table sugar) and foods or drinks containing sugars or starches may be ineffective because acarbose prevents their breakdown and absorption.

Possible interactions

Other medicaments:

Acarbose may increase the effects of:

• insulins, further lowering blood sugar for patients who do not respond to acarbose alone.
• metformin (Glucophage) may further lower blood sugar for patients who are not controlled by diet or acarbose alone.
• sulfonylureas, causing further lowering of blood sugars (not an acarbose effect). This may be used for therapeutic benefit.
• warfarin (Coumadin)-INR testing more often is advisable.

Acarbose taken concurrently with:

• activated charcoal (various) may blunt the benefits of acarbose.
• amylase (Pancreatin) may blunt the benefits of acarbose.
• clofibrate (Atromid-S) may result in hypoglycemia.
• digestive enzyme products that contain amylase or lipase may result in loss of blood sugar control.
• digoxin (Lanoxin) may cause lower (subtherapeutic) blood levels of digoxin and loss of benefits (one case report).
• disopyramide (Norpace) may result in hypoglycemia.
• high-dose aspirin or other salicylates and some NSAIDs may result in hypoglycemia.
• insulin increases risk of low blood sugar.
• monoamine oxidase (MOA) inhibitors may increase glucose tolerance.
• sulfonamide antibiotics may pose an increased risk for low blood sugar (hypoglycemia).

The following medicaments may decrease the effects of acarbose:

• adrenocorticosteroids.
• beta-blockers.
• calcium channel blockers.
• furosemide (Lasix) and bumetanide (Bumex).
• isoniazid (INH).
• nicotinic acid.
• pancreatin (or any medicines containing carbohydrate dividing enzymes such as amylase or pancreatin).
• phenytoin (Dilantin).
• rifampin (Rifadin, others).
• theophylline (Theo-Dur, others).
• thiazide diuretics.
• thyroid hormones.

Foods:

Closely follow the diet your doctor has prescribed. Blood sugar control can help avoid or delay diabetes problems. Vitamin C in high dose may worsen blood sugar control.

Herbal medicines or minerals:

Using chromium may change the way your body is able to use sugar. Some health food stores advocate vanadium as mimicking the actions of insulin, but possible toxicity and need for rigorous studies presently preclude recommending it. DHEA may change sensitivity to insulin or insulin resistance. Hawthorn, ginger, garlic, ginseng and licorice, nettle and yohimbe may change blood sugar. Since this may require adjustment of hypoglycemic medicine dosing, talk to your doctor before combining any of these herbal medicines with acarbose. Echinacea pupurea (injectable) and blonde psyllium seed or husk should not be taken by people living with diabetes.

Driving Hazardous Activities:

Use caution until degree of drowsiness you may see is known.

Heavy exercise or exertion:

Caution advised because this medicament lowers peak in blood sugar after meals. Discuss dosing changes with your doctor.

Occurrence of unrelated illness:

Illness can change blood sugar control. Temporary use of insulin may be required.

Discontinuation:

Never stop acarbose before calling your doctor.