Acarbose

 Action Inhibits intestinal enzymes that digest carbohydrate, thereby reducing carbohydrate digestion after meals. This lowers postprandial glucose elevation in diabetics.

 Indications Patients with NIDDM who have failed dietary therapy. May be used alone or in combination with sulfonylureas.

 Contraindications Diabetic ketoacidosis; cirrhosis; inflammatory bowel disease; colonic ulceration; intestinal disorders of digestion or absorption; partial or predisposition to intestinal obstruction; conditions that may deteriorate as a result of increased intestinal gas production.

 Route/Dosage

ADULTS: PO 25 mg tid with the start of each meal. Increase by 25 mg/dose at 4 to 8 week intervals according to response up to a max based on blood glucose response (max: 150/day if < 60 kg; 300 mg/day if > 60 kg).

 Interactions

Intestinal absorbents (eg, charcoal); digestive enzymes: May lower the efficacy of acarbose. Drugs that produce hyperglycemia (eg, corticosteroids, diuretics, thyroid preparations): May lead to loss of glucose control.

 Lab Test Interferences None well documented.

 Adverse Reactions

GI: Abdominal pain; diarrhea; flatulence. HEPA: Elevated serum transaminases rarely associated with jaundice.

 Precautions

Pregnancy: Category B. Insulin is recommended to maintain blood glucose levels during pregnancy. Lactation: Undetermined. Children: Safety and efficacy not established. Hypoglycemia: Acarbose does not produce hypoglycemia; however, hypoglycemia may develop if used together with sulfonylureas. Loss of blood glucose control: Certain medical conditions (eg, surgery, fever, infection, trauma) and drugs (eg, diuretics, corticosteroids, oral contraceptives) affect glucose control. In these situations, it may be necessary to adjust dose of acarbose and other antidiabetic drugs. Renal impairment: Acarbose not recommended.

 Administration/Storage

• Take the medication at the start (ie, first bite) of each meal.
• Store < 25°C (77°F), in a tightly-closed container, protected from moisture.

 Assessment/Interventions

• Assess renal function prior to starting medication.
• Therapy is monitored by periodic blood glucose tests.
• Check serum transaminases every 3 months during the first year of treatment.
• Assess for hypoglycemia if this medication is combined with a sulfonylurea.
• If hypoglycemia develops, use oral or parenteral glucose to increase blood glucose instead of sucrose (table sugar), since metabolism of sucrose is inhibited by acarbose.

 Patient/Family Education

• Advise patient to take the drug with first bite of each meal. May be taken during the meal if not taken with the first bite. Do not take after meal is completed.
• Encourage patient to participate in regular physical activity and follow diabetic meal plan.
• Counsel patient on regular monitoring of blood glucose.
• Advise women of childbearing age that this medication should not be used during pregnancy. Insulin is preferred agent to control blood glucose.
• Advise patient/family that “cane sugar” (sucrose) should not be used to treat hypoglycemia reactions. Glucose or glucagon are necessary to increase blood sugar.
• Advise patient to inform health care provider if gas, diarrhea, or abdominal discomfort occurs.