Acarbose

1. Introduction

Acarbose is an alpha-glucosidase inhibitor (AGI) used to lower blood sugar levels in patients with type 2 diabetes mellitus (T2DM). It works by delaying carbohydrate digestion and absorption in the small intestine, leading to a slower rise in postprandial blood glucose levels.

2. Indications

  • Type 2 Diabetes Mellitus (T2DM) (as monotherapy or in combination with other antidiabetic drugs)
  • Prediabetes (Off-Label Use) (to prevent progression to diabetes)

3. Dosage

Adults (Type 2 Diabetes):

  • Starting dose: 25 mg three times daily with the first bite of each meal.
  • Maintenance dose: 50–100 mg three times daily.
  • Max dose:
    • ≤60 kg: 50 mg three times daily.
    • >60 kg: 100 mg three times daily.

Elderly (>65 years):

  • No dose adjustment needed but start at lower doses to reduce GI side effects.

Renal Impairment:

  • Contraindicated if CrCl <25 mL/min.

Hepatic Impairment:

  • Use with caution; monitor liver enzymes periodically.

4. Administration

  • Take with the first bite of each meal to be effective.
  • Chew or swallow whole with water—do not crush.
  • If a meal is skipped, skip that dose.

5. Forms Available

  • Tablets: 25 mg, 50 mg, 100 mg

6. Side Effects

6.1 Common Side Effects:

  • Flatulence (very common)
  • Bloating
  • Diarrhoea
  • Abdominal pain

6.2 Less Common Side Effects:

  • Nausea
  • Indigestion

6.3 Rare but Serious Side Effects:

  • Hepatotoxicity (increased liver enzymes)
  • Severe gastrointestinal obstruction
  • Hypoglycaemia (only if combined with insulin or sulfonylureas)

7. Warnings

  • Severe Flatulence & GI Symptoms: Due to fermentation of undigested carbohydrates—symptoms improve over time.
  • Hepatic Toxicity Risk: Monitor liver enzymes every 3 months during the first year.
  • Hypoglycaemia Risk (if combined with sulfonylureas or insulin): Use glucose (not sucrose) for correction, as acarbose inhibits sucrose breakdown.

8. Precautions

  • Avoid in inflammatory bowel disease (IBD) and intestinal obstruction.
  • Use with caution in patients with liver disease—monitor liver function.
  • Not effective in fasting hyperglycaemia—only works on postprandial glucose levels.

9. Interactions

  • Metformin & Sulfonylureas: Increased risk of hypoglycaemia.
  • Digoxin: Acarbose may reduce digoxin absorption—monitor digoxin levels.
  • Activated Charcoal & Digestive Enzyme Supplements: May reduce acarbose effectiveness.

10. Monitoring Parameters

  • Postprandial blood glucose levels (PPG).
  • Liver function tests (ALT, AST) every 3 months for the first year.
  • HbA1c every 3–6 months for diabetes control.

11. Use in Children

  • Not recommended for use in children—safety and efficacy not established.

12. Use in Pregnancy

  • Category B:
    • Not commonly used in pregnancy—metformin or insulin preferred.

13. Use in Elderly

  • Safe but start with a lower dose (25 mg twice daily) to reduce GI side effects.

14. Use in Kidney Disease

  • Contraindicated in severe renal impairment (CrCl <25 mL/min).

15. Use in Liver Disease

  • Use with caution—monitor liver function closely.

16. Patient Counselling Points

  • Take with the first bite of food at each meal.
  • Do not use table sugar (sucrose) to treat hypoglycaemia—use glucose or honey instead.
  • Gastrointestinal side effects (gas, bloating) are common but may improve over time.
  • Report symptoms of liver dysfunction (dark urine, jaundice, fatigue).
  • If a meal is skipped, skip that dose.

17. Table of Brand Names, Manufacturer, and Prices in USD

Brand NameManufacturerStrength/Dosage FormPrice (USD)
PrecoseBayer25 mg, 50 mg, 100 mg Tablets$100 (30 tabs)
GlucobayBayer25 mg, 50 mg, 100 mg Tablets$90 (30 tabs)
Generic AcarboseVarious25 mg, 50 mg, 100 mg Tablets$50 (30 tabs)

18. 15 FAQs (Frequently Asked Questions)

1. What is Acarbose used for?
It is used to control postprandial blood glucose levels in type 2 diabetes.

2. How does Acarbose work?
It delays carbohydrate digestion, leading to a slower rise in blood sugar after meals.

3. Does Acarbose cause hypoglycaemia?
Not by itself, but it may cause hypoglycaemia if combined with sulfonylureas or insulin.

4. How long does Acarbose take to work?
It starts working with the first dose, but full effects are seen in weeks.

5. Can I take Acarbose on an empty stomach?
No, it must be taken with food to be effective.

6. What happens if I miss a dose?
Skip it and take the next dose with your next meal—do not double the dose.

7. Can Acarbose cause bloating and gas?
Yes, flatulence is common but improves over time.

8. Can I drink alcohol while taking Acarbose?
Moderation is advised—alcohol may affect blood sugar control.

9. Can I take Acarbose with metformin?
Yes, but it may increase GI side effects like diarrhoea and bloating.

10. Does Acarbose help with weight loss?
It does not directly cause weight loss but prevents post-meal blood sugar spikes.

11. Can I take Acarbose if I have kidney disease?
No, it is contraindicated in severe renal impairment (CrCl <25 mL/min).

12. Can Acarbose cause liver damage?
Rarely, monitor liver enzymes every 3 months in the first year.

13. Can I stop taking Acarbose suddenly?
Yes, but stopping may lead to higher post-meal blood sugars.

14. Is Acarbose better than metformin?
It depends—Acarbose mainly controls postprandial glucose, while metformin lowers fasting glucose.

15. How should Acarbose be stored?
Store at room temperature, away from moisture and heat.