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 ?
Miglitol: a review of its therapeutic potential in type 2 diabetes mellitus.
Miglitol has a -C[H.sub.2] group at the 6th position in its side chain and at a cyclic structure.
Jutabha et al, "Distinct action of the [alpha]-glucosidase inhibitor miglitol on SGLT3, enteroendocrine cells, and GLP1 secretion," Journal of Endocrinology, vol.
As the name implies, compounds available in this class--acarbose (FDA 1995), miglitol (FDA 1996), and voglibose (developed in Japan and available since 1994)--inhibit the enzyme responsible for breakdown of oligosaccharides into disaccharides at the intestinal brush border [8].
At present, [alpha]-glucosidase inhibitors widely prescribed as antidiabetic agents such as acarbose, miglitol, and voglibose have shown the gastrointestinal side effects.
At the present, three antiglucosidase drugs, acarbose [24], miglitol [25], and voglibose [26], have been therapeutically used for non-insulin-dependent diabetes (type 2).
More interestingly, 1,2-O-isopropylidene-a-D-glucofuranose obtained from the hydrolysis of 1,2:5,6-di-O-isopropylidene-a-D-glucofuranose is often used to synthesize medicinal products such as 1-deoxynojirimycin and miglitol [6].
Miglitol and Acarbose both delay the digestion of carbohydrates in the body, also with very minimal side-effects.
(Farxiga[R]) Alpha-glucosidase Acarbose Blocks the breakdown inhibitors (Precose[R]) of starches in the Miglitol intestine and may slow (Glyset[R]) the breakdown of other sugars.
[alpha]-Glucosidase inhibitors (e.g., miglitol [Glyset[R]], acarbose [Precose[R]]) delay the absorption of carbohydrates by inhibiting conversion of oligosaccharides to monosaccharides in the intestine and thus lower postprandial blood glucose and insulin concentration (ADA, 2015).
The treatment approach for type 2 diabetes includes several conventional therapeutics, namely, sulfonylureas and repaglinide enhance insulin secretion, troglitazone increases insulin action in fat and muscle, metformin promotes insulin mechanism in liver tissue, and miglitol and acarbose enact delayed carbohydrate absorption from food intake, respectively [13].