miglitol


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miglitol

 [mig´lĭ-tol]
an antidiabetic agent that by inhibiting α-glucosidases of the intestinal brush border delays the breakdown of ingested sugars, slowing the absorption of glucose into the bloodstream and reducing postprandial hyperglycemia; used in the treatment of type 2 diabetes mellitus, administered orally.

miglitol

Glyset

Pharmacologic class: Alpha-glucosidase inhibitor

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Inhibits alpha-glucosidases, which convert oligosaccharides and disaccharides to glucose. This inhibition causes blood glucose reduction (especially in postprandial hyperglycemia).

Availability

Tablets: 25 mg, 50 mg, 100 mg

Indications and dosages

Adjunct to diet in non-insulin-dependent (type 2) diabetes mellitus or combined with a sulfonylurea when diet plus either miglitol or a sulfonylurea alone doesn't control hyperglycemia

Adults: 25 mg P.O. t.i.d. with first bite of each main meal. After 4 to 8 weeks, may increase to 50 mg P.O. t.i.d. After 3 months, adjust dosage further based on glycosylated hemoglobin (HbA1c) level, to a maximum of 100 mg P.O. t.i.d.

Contraindications

• Hypersensitivity to drug or its components
• Insulin-dependent (type 1) diabetes mellitus, diabetic ketoacidosis
• Chronic intestinal disorder associated with marked digestive or absorptive disorders or conditions that may deteriorate due to increased gas formation
• Inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, or predisposition to intestinal obstruction

Precautions

Use cautiously in:
• significant renal impairment (safety not established)
• fever, infection, trauma, stress
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with first bite of three main meals.

Adverse reactions

GI: abdominal pain, diarrhea, flatulence

Skin: rash

Interactions

Drug-drug.Digestive enzyme preparations (such as amylase), intestinal absorbents (such as charcoal): reduced miglitol efficacy

Digoxin, propranolol, ranitidine: decreased bioavailability of these drugs

Drug-diagnostic tests.Serum iron: below-normal level

Drug-food.Carbohydrates: increased diarrhea

Patient monitoring

• Monitor CBC, blood glucose, and HBA1c levels.
• Watch for hyperglycemia or hypoglycemia, especially if patient also takes insulin or oral sulfonylureas.

Patient teaching

• Instruct patient to take drug three times daily with first bite of three main meals.
• Advise patient to take drug as prescribed. If appropriate, tell him he may need insulin during periods of increased stress, infection, or surgery.
• Teach patient about diabetes. Stress importance of proper diet, exercise, weight control, and blood glucose monitoring.
• Inform patient that sucrose (as in table sugar) and fruit juice don't effectively treat miglitol-induced hypoglycemia. Advise him to use dextrose or glucagon instead to raise blood glucose level quickly.
• Tell patient drug may cause abdominal pain, diarrhea, and gas. Reassure him that these effects usually subside after several weeks.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

miglitol

/mig·li·tol/ (mig´lĭ-tol) an enzyme inhibitor that slows the absorption of glucose into the bloodstream and reduces postprandial hyperglycemia; used in the treatment of type 2 diabetes.

miglitol

(mĭg′lĭ-tôl′)
n.
A drug, C8H17NO5, that reduces blood glucose levels by inhibiting the breakdown of complex carbohydrates in the intestine and is used to treat type 2 diabetes.

miglitol

an oral hypoglycemic.
indication It is used to treat type 2 diabetes mellitus.
contraindications Factors that prohibit its use include known hypersensitivity to miglitol, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, and chronic intestinal disease.
adverse effects Hepatotoxicity is a life-threatening side effect. Other adverse effects are low iron and rash. Common side effects are abdominal pain, diarrhea, and flatulence.
References in periodicals archive ?
Because of the importance of 1,2-O-isopropylidene-a-D-glucofuranose (2a) as a necessary material in synthesis of 1-deoxynojirimycin and miglitol [6], the catalytic potential of S-CKT was evaluated for the preparation 2a from 1,2:5,6-di-O-isopropylidene- a-D-glucofuranose (1a) by the selective hydrolysis reaction (Scheme-1).
Acarbose and voglibose are excreted through the faecal route, while miglitol is excreted by the kidneys.
Medications currently approved to treat type 2 diabetes, 2010 Mean Maximum daily daily Class Drugs doses doses Biguanide Metformin 850 mg (a) 2 550 mg Sulfonylureas Chlorpropamide 250 mg (b) 500 mg Glibenclamide 5 mg (a) 20 mg Glipizide 5 mg (a) 20 mg Glimepiride 4 mg (b) 8 mg Gliclazide 80 mg (a) 320 mg Gliclazide MR 60 mg (b) 120 mg Meglitinides Nateglinide 60 mg (c) 360 mg Repaglinide 2 mg (c) 12 mg Thiazolidinediones Rosiglitazone 4 mg (a) 8 mg Pioglitazone 30 mg (b) 45 mg a-glucosidase Acarbose 50 mg (c) 300 mg inhibitors Miglitol 25 mg (c) 100 mg DPP-4 inhibitors/ Sitagliptin 100 mg (b) 100 mg gliptines Vildagliptin 50 mg (a) 100 mg Saxaglipnin 5 mg (b) 5 mg Incretine analogues Exenatide 20 mcgr (a) 20 mcgr Liraglutide 1.
The two alpha-glucosidase inhibitors acarbose (Precose) and miglitol (Glyset) delay the digestion of carbohydrates within the gastrointestinal tract, thereby reducing the rise in blood glucose following meals.
Acarbose (Precose[R]) and miglitol (Glyset[R]) slow carbohydrate absorption in the small intestine, thereby giving the pancreas time to secrete sufficient insulin to moderate postprandial blood glucose levels.
As competitive and reversible a-glucosidase inhibitors, acarbose and miglitol inhibit glucose absorption in the intestine (Van Gaal et al.
Eslami says medications that are safe and effective in treating type 2 diabetes include alpha-glucosidase inhibitors such as acarbose (Precose) or miglitol (Glyset), or meglitinides such as repaglinide (Prandin) and nateglinide (Starlix).
If you use the prescription medications acarbose (Precose[R]) or miglitol (Glyset[R]), consult your physician before using pancreatin.
Currently, anti-diabetic drugs acting through inhibiting carbohydrate absorption from the intestine are usually [alpha]-glucosidase inhibitors, such as acarbose and miglitol, which inhibit the breakdown of complex carbohydrates into simple ones in order to reduce glucose absorption and hence only work with a meal containing complex carbohydrates (Bischoff, 1994; Yee and Fong, 1996).
These agents in clude the [alpha]-glucosidase inhibitors acarbose and miglitol, the amylin analog pramlintide, the dipeptidyl peptidase-4 inhibitor sitagliptin phosphate, the glinides nateglinide and repaglinide, the glucagon-like peptide-1 derivative exenatide, and rapid-acting, biphasic, and inhaled insulins.
There are now two alpha-glucosidase inhibitors (AL-fa gloo-KOS-ih-dayss in-HIB-it-ers): acarbose (AK-er-bose) and miglitol (MIG-lih-tall).