Precose

Precose,

trademark for an antidiabetic agent (acarbose).

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acarbose Warning - High-alert drug!

Glucobay (UK), Prandase (CA), Precose

Pharmacologic class: Alpha-glucosidase inhibitor

Therapeutic class: Hypoglycemic

Pregnancy risk category B

Action

Improves blood glucose control by slowing carbohydrate digestion in intestine and prolonging conversion of carbohydrates to glucose

Availability

Tablets: 25 mg, 50 mg, 100 mg

⊘Indications and dosages

➣ Treatment of type 2 (non-insulin-dependent) diabetes mellitus when diet alone doesn't control blood glucose

Adults: Initially, 25 mg P.O. t.i.d. Increase q 4 to 8 weeks as needed until maintenance dosage is reached. Maximum dosage is 100 mg P.O. t.i.d. for adults weighing more than 60 kg (132 lb); 50 mg P.O. t.i.d. for adults weighing 60 kg or less.

Contraindications

• Hypersensitivity to drug
• Renal dysfunction
• Type 1 diabetes mellitus, diabetic ketoacidosis
• GI disease
• Cirrhosis
• Colonic ulcers
• Inflammatory bowel disease
• Intestinal obstruction
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• patients receiving concurrent hypoglycemic drugs
• children.

Administration

• Give with first bite of patient's three main meals.
• Know that drug prevents breakdown of table sugar (sucrose). Thus, mild hypoglycemia must be corrected with oral glucose (such as D-glucose or dextrose), and severe hypoglycemia may warrant I.V. glucose or glucagon injection.
• Be aware that drug may be used alone or in combination with insulin, metformin, or sulfonylureas (such as glipizide, glyburide, or glimepiride).

Route	Onset	Peak	Duration
P.O.	Rapid	1 hr	Unknown

Adverse reactions

GI: diarrhea, abdominal pain, flatulence

Metabolic: hypoglycemia (when used with insulin or sulfonylureas)

Other: edema, hypersensitivity reaction (rash)

Interactions

Drug-drug. Activated charcoal, calcium channel blockers, corticosteroids, digestive enzymes, diuretics, estrogen, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, phenytoin, sympathomimetics, thyroid products: decreased therapeutic effect of acarbose

Digoxin: decreased digoxin blood level and reduced therapeutic effect

Insulin, sulfonylureas: hypoglycemia

Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase: increased levels

Calcium, vitamin B₆: decreased levels

Hematocrit: decreased

Patient monitoring

• Monitor patient for hypoglycemia if he's taking drug concurrently with insulin or sulfonylureas.
• Stay alert for hyperglycemia during periods of increased stress.
• Assess GI signs and symptoms to differentiate drug effects from those caused by paralytic ileus.
• Check 1-hour postprandial glucose level to gauge drug's efficacy.
• Monitor liver function test results. Report abnormalities so that dosage adjustments may be made as needed.

Patient teaching

• Inform patient that drug may cause serious interactions with many common medications, so he should tell all prescribers he's taking it.
• Teach patient about other ways to control blood glucose level, such as recommendations regarding diet, exercise, weight reduction, and stress management.
• Stress importance of testing urine and blood glucose regularly.
• Teach patient about signs and symptoms of hypoglycemia. Tell him that although this drug doesn't cause hypoglycemia when used alone, hypoglycemic symptoms may arise if he takes it with other hypoglycemics.
• Urge patient to keep oral glucose on hand to correct mild hypoglycemia; inform him that sugar in candy won't correct hypoglycemia.
• Inform patient that GI symptoms such as flatulence may result from delayed carbohydrate digestion in intestine.
• Advise patient to obtain medical alert identification and to carry or wear it at all times.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

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Precose®

Acarbose Endocrinology An agent used with metformin– Glucophage^® or insulin to control postprandial glucose spikes in Pts with type 2 DM, or as monotherapy to ↓ blood glucose levels in type 2 DM unresponsive to diet alone, administered with a sulfonylurea– Glucotrol^™–eg, when diet and a sulfonylurea don't adequately control glycemia. See Diabetes mellitus.