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Pharmacologic class: Alpha-glucosidase inhibitor
Therapeutic class: Hypoglycemic
Pregnancy risk category B
Improves blood glucose control by slowing carbohydrate digestion in intestine and prolonging conversion of carbohydrates to glucose
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.
• Hypersensitivity to drug
• Renal dysfunction
• Type 1 diabetes mellitus, diabetic ketoacidosis
• GI disease
• Colonic ulcers
• Inflammatory bowel disease
• Intestinal obstruction
• Pregnancy or breastfeeding
Use cautiously in:
• patients receiving concurrent hypoglycemic drugs
• 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).
GI: diarrhea, abdominal pain, flatulence
Metabolic: hypoglycemia (when used with insulin or sulfonylureas)
Other: edema, hypersensitivity reaction (rash)
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
• 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.
• 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.
Pharmacologic: alpha glucosidase inhibitors
Time/action profile (effect on blood glucose)
Adverse Reactions/Side Effects
- abdominal pain (most frequent)
- diarrhea (most frequent)
- flatulence (most frequent)
- ↑ transaminases
Drug-Drug interactionThiazide 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.
Availability (generic available)
- 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.
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.
- 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.
Potential Nursing DiagnosesImbalanced nutrition: more than body requirements (Indications)
Noncompliance (Patient/Family Teaching)
- 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.
- 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.
- Control of blood glucose levels without the appearance of hypoglycemic or hyperglycemic episodes.