Precose


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acarbose

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).

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.

acarbose

(aye-kar-bose) ,

Precose

(trade name)

Classification

Therapeutic: antidiabetics
Pharmacologic: alpha glucosidase inhibitors
Pregnancy Category: B

Indications

Management of type 2 diabetes in conjunction with dietary therapy; may be used with insulin or other hypoglycemic agents.

Action

Lowers blood glucose by inhibiting the enzyme alpha-glucosidase in the GI tract. Delays and reduces glucose absorption.

Therapeutic effects

Lowering of blood glucose in diabetic patients, especially postprandial hyperglycemia.

Pharmacokinetics

Absorption: <2% systemically absorbed; action is primarily local (in the GI tract).
Distribution: Unknown.
Metabolism and Excretion: Minimal amounts absorbed are excreted by the kidneys.
Half-life: 2 hr.

Time/action profile (effect on blood glucose)

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Contraindications/Precautions

Contraindicated in: Hypersensitivity;Diabetic ketoacidosis;Cirrhosis;Serum creatinine >2 mg/dL; Obstetric / Lactation / Pediatric: Safety not established.
Use Cautiously in: Presence of fever, infection, trauma, stress (may cause hyperglycemia, requiring alternative therapy).

Adverse Reactions/Side Effects

Gastrointestinal

  • abdominal pain (most frequent)
  • diarrhea (most frequent)
  • flatulence (most frequent)
  • ↑ transaminases

Interactions

Drug-Drug interaction

Thiazide diuretics and loop diuretics, corticosteroids, phenothiazines, thyroid preparations, estrogens (conjugated), progestins, hormonal contraceptives, phenytoin, niacin, sympathomimetics, calcium channel blockers, and isoniazid may ↑ glucose levels in diabetic patients and lead to ↓ control of blood glucose.Effects are↓ by intestinal adsorbents, including activated charcoal and digestive enzyme preparations (amylase, pancreatin) ; avoid concurrent use.↑ effects of sulfonylurea hypoglycemic agents.May ↓ absorption of digoxin ; may require dosage adjustment.Glucosamine may worsen blood glucose control.Chromium and coenzyme Q-10 may ↑ hypoglycemic effects.

Route/Dosage

Oral (Adults) 25 mg 3 times daily; may be increased q 4–8 wk as needed/tolerated (range 50–100 mg 3 times daily; not to exceed 50 mg 3 times daily in patients ≤60 kg or 100 mg 3 times daily in patients >60 kg).

Availability (generic available)

Tablets: 25 mg, 50 mg, 100 mg

Nursing implications

Nursing assessment

  • Observe patient for signs and symptoms of hypoglycemia (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety) when taking concurrently with other oral hypoglycemic agents.
  • Lab Test Considerations: Monitor serum glucose and glycosylated hemoglobin periodically during therapy to evaluate effectiveness.
    • Monitor AST and ALT every 3 mo for the 1st yr and then periodically. Elevated levels may require dose reduction or discontinuation of acarbose. Elevations occur more commonly in patients taking more than 300 mg/day and in female patients. Levels usually return to normal without other evidence of liver injury after discontinuation.
  • Symptoms of overdose are transient increase in flatulence, diarrhea, and abdominal discomfort. Acarbose alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia requiring treatment.

Potential Nursing Diagnoses

Imbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
    • Does not cause hypoglycemia when taken while fasting, but may increase hypoglycemic effect of other hypoglycemic agents.
  • Oral: Administer with first bite of each meal 3 times/day.

Patient/Family Teaching

  • Instruct patient to take acarbose at same time each day. If a dose is missed and the meal is completed without taking the dose, skip missed dose and take next dose with the next meal. Do not double doses.
  • Explain to patient that acarbose controls hyperglycemia but does not cure diabetes. Therapy is longterm.
  • Review signs of hypoglycemia and hyperglycemia (blurred vision; drowsiness; dry mouth; flushed, dry skin; fruit-like breath odor; increased urination; ketones in urine; loss of appetite; stomachache; nausea or vomiting; tiredness; rapid, deep breathing; unusual thirst; unconsciousness) with patient. If hypoglycemia occurs, advise patient to take a form of oral glucose (e.g., glucose tablets, liquid gel glucose) rather than sugar (absorption of sugar is blocked by acarbose) and notify health care professional.
  • Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hypoglycemic or hyperglycemic episodes.
  • Instruct patient in proper testing of serum glucose and urine ketones. Monitor closely during periods of stress or illness. Notify health care professional if significant changes occur.
  • Caution patient to avoid using other medications without consulting health care professional.
  • Advise patient to inform health care professional of medication regimen before treatment or surgery.
  • Advise patient to carry a form of oral glucose and identification describing disease process and medication regimen at all times.
  • Emphasize the importance of routine follow-up examinations.

Evaluation/Desired Outcomes

  • Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.

Precose

a trademark for an antidiabetic agent (acarbose).

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.
References in periodicals archive ?
Other Names for This Medicine Generic Name Brand Name acarbose Precose miglitol Glyset
Food and Drug Administration (FDA) to market Precose (acarbose tablets) to be used in combination with insulin or metformin for patients with Type 2 diabetes.
Precose may be added to the treatment regimen for patients whose Type 2 diabetes is inadequately controlled by insulin or metformin to further reduce both the postprandial (after meal) blood glucose spikes (levels) and the HbAlc (a measure of long term blood glucose control).
Professor Rury Holman, co-director of the UKPDS, said that patients experienced a very similar reduction in HbA1c over the three-year study period regardless of which existing therapy Precose was added to -- insulin, sulphonylurea, metformin or diet alone.
In order to improve compliance, he said it was important to explain that different therapies act in different ways -- insulin and sulphonylureas primarily reduce fasting glucose levels, and Precose mainly brings down postprandial glucose (glucose levels after meals).
Glyset, like Precose, slows down the digestion and absorption of
diabetes, Glyset and Precose do not cause hypoglycemia, hyperinsulinemia
2 /PRNewswire/ -- Bayer Corporation, Pharmaceutical Division, announced today the commercial availability of Precose (acarbose tablets), the first of a new class of drugs for treating Type II (non-insulin-dependent) diabetes mellitus.
By slowing the digestion of carbohydrates, Precose is the first pharmacological agent to use the gut as a means to treat diabetes.
Precose is First of a New Class of Antidiabetic Agents
blood glucose levels, Precose may help reduce long-term complications of
NOTE TO EDITORS: Precose and Glucobay are Miles trade names.