miglitol

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.

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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.

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miglitol Warning - High-alert drug!

Glyset

Pharmacologic class: Alphaglucosidase 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.

Route	Onset	Peak	Duration
P.O.	Unknown	2-3 hr	Unknown

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.