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

(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.
References in periodicals archive ?
Precose and Glyset are also insulin-sparing agents with a modest effect on HgA1c, but they require careful titration because of their excessive flatulence and laxative effect.
Other names for this medicine Generic name Brand name acarbose Precose miglitol Glyset
Firsttrimester experience with acarbose (Precose) and miglitol (Glyset), which lower postprandial hyperglycemia by delaying glucose absorption, is very limited, so they are not recommended for the treatment of type 2 diabetes in pregnancy or GDM.
* Acknowledgments Find Your Diabetes Medicines(*) Sulfonylureas Amaryl DiaBeta Diabinese Dymelor Glucotrol Glucotrol XL Glynase PresTab Micronase Orinase Tolinase Biguanides Glucophage Alpha-glucosidase Inhibitors Glyset Precose Thiazolidinediones Rezulin Meglitinides: Prandin Insulins Lispro (Humalog) Regular Premixed Ultralente NPH or Lente
The product, to be marketed under the trade name of Glyset, is indicated for managing Type 2 diabetes.
First-trimester experience with acarbose (Precose) and miglitol (Glyset), which lower postprandial hyperglycemia by delaying glucose absorption, is very limited, so they are not recommended for the treatment of type 2 diabetes in pregnancy or GDM.
pioglitazone 15-45 mg/day $4.74 (Actos) (30 mg/day) rosiglitazone 4-8 mg/day, $2.56 once or divided (4 mg) GLUCOSIDASE INHIBITORS acarbose 25-100 mg $1.74 (Precose) before meals (50 mg t.i.d) miglitol 25-100 mg $1.95 (Glyset) before meals (50 mg t.i.d.) pioglitazone Lowers triglycerides and raises (Actos) high-density lipoprotein cholesterol; neutral effect on low-density lipoprote (LDL) cholesterol.
pioglitazone 15-45 mg/day $4.74 (Actos) (30 mg/day) rosiglitazone 4-8 mg/day, $2.56 (Avandia) once or divided (4 mg) GLUCOSIDASE INHIBITORS acarbose 25-100 mg $1.74 (Precose) before meals (50 mg t.i.d.) miglitol 25-100 mg $1.95 (Glyset) before meals (50 mg t.i.d.) Drug Comment ** BIGUANIDE metformin Only biguanide currently available in United States.