Acarbose

Indication & Dosage

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) <25 ; Contra-indicated.

Administration

Should be taken with food. (Take w/ 1st bite of each main meal.)

Overdosage

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.

Contraindications

Patients <18 yr; diabetic ketoacidosis or cirrhosis; malabsorption; inflammatory bowel disease; with or predisposed 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.

Special 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 Drug Reactions

Flatulence, abdominal pain, distension, diarrhoea, nausea, vomiting. Elevation of transaminases, hepatitis, jaundice. Rarely, skin reactions.

Potentially Fatal: Hepatotoxicity.

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.

Pregnancy Category (US FDA)

Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).

Storage: Store below 25°C.

Mechanism of Action

Acarbose competitively and reversibly inhibits pancreatic a-amylase and intestinal brush border a-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.

Brands : ABACUS-50 tab ACARB tab ACAREX tab ACARWIN tab ASUCROSE tab DIABOSE tab DIADOSE tab GLUBOSE tab GLUCAR tab GLUCOBAY tab GLUCOBOSE tab GLUDASE tab K-CARB tab REBOSE tab RECARB tab SUBASE tab ZEBOSE tab

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Acarbose

Indications Type 2 DM.

Dosage Adult: PO Initial: 25 mg/day. May adjust gradually. Maintenance: 50-100 mg 3 times/day. Max: ≤60 kg: 50 mg 3 times/day; >60 kg: 100 mg 3 times/day.

Administration Should be taken with food. (Take w/ 1st bite of each main meal.)

Overdosage For action to be taken in the event of accidental overdose

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.

Special 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 Drug Reactions Flatulence, abdominal pain, distension, diarrhoea, nausea, vomiting. Elevation of transaminases, hepatitis, jaundice. Rarely, skin reactions.

Potentially Fatal: Hepatotoxicity.

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.

GLUBOSE Tab

Manufacturer Aristo (Otsira)

Contents acarbose.

GLUBOSE tab

50 mg x 10's (65 INR)

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