Acarbose

Indications

Acarbose is used to control blood sugar in adults with type 2 diabetes, together with diet and exercise. It can be used alone or with other diabetes medicines such as Metformin, Sulphonylureas or Insulin. It mainly lowers the rise in blood sugar after meals.

How It Works

Acarbose is an alpha-glucosidase inhibitor. It blocks enzymes in the small intestine that break down starch and table sugar into glucose. Carbohydrates are therefore digested and absorbed more slowly, so blood sugar rises less sharply after eating.

Dosage and Administration

Take exactly as prescribed. Treatment usually starts at 50 mg three times a day (some doctors start at 25 mg) and may be increased after several weeks to 100 mg three times a day. Swallow the tablet whole with the first bite of each main meal, or chew it with the first mouthful. If you skip a meal, skip that dose.

Interactions

• With Sulphonylureas or Insulin, low blood sugar (hypoglycaemia) can occur. Treat it with glucose (dextrose) tablets or a glucose drink, not table sugar, because Acarbose blocks sugar breakdown.
• Antacids, digestive enzyme products, Cholestyramine and intestinal adsorbents (such as charcoal) may reduce its effect.
• It may change the absorption of Digoxin.

Contraindications

• Allergy to Acarbose.
• Inflammatory bowel disease, bowel ulcers, partial bowel blockage, or a tendency to bowel blockage.
• Large hernias and conditions that worsen with increased gas in the bowel.
• Severe kidney or liver impairment.
• Diabetic ketoacidosis.

Side Effects

The most common side effects are wind, bloating, stomach rumbling, abdominal discomfort and diarrhoea, especially after high-sugar foods. These usually lessen with time. Raised liver enzymes can occur at higher doses.

Get urgent medical help if you have severe stomach pain with swelling or no bowel movements (possible blockage), yellow skin or eyes, signs of severe low blood sugar (confusion, fainting, seizure), or a severe allergic reaction.

Pregnancy and Lactation

Acarbose is not recommended in pregnancy; Insulin is usually preferred to control diabetes during pregnancy. It is not recommended while breastfeeding.

Precautions and Warnings

• Avoid large amounts of table sugar, which increase stomach side effects.
• Liver tests may be checked, especially in the first year at higher doses.
• Carry glucose tablets if you also take other diabetes medicines that can cause low blood sugar.
• Keep up regular blood sugar and HbA1c checks.

Overdose

Overdose taken with food may cause marked wind, bloating and diarrhoea; it does not usually cause low blood sugar by itself. Avoid carbohydrate-containing food and drinks for 4 to 6 hours and contact a doctor.

Therapeutic Class

Oral antidiabetic, alpha-glucosidase inhibitor.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.