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Pharmacologic class: Alpha-glucosidase inhibitor
Therapeutic class: Hypoglycemic
Pregnancy risk category B
Inhibits alpha-glucosidases, which convert oligosaccharides and disaccharides to glucose. This inhibition causes blood glucose reduction (especially in postprandial hyperglycemia).
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.
• 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
Use cautiously in:
• significant renal impairment (safety not established)
• fever, infection, trauma, stress
• pregnant or breastfeeding patients
• children (safety not established).
• Give with first bite of three main meals.
GI: abdominal pain, diarrhea, flatulence
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
• Monitor CBC, blood glucose, and HBA1c levels.
• Watch for hyperglycemia or hypoglycemia, especially if patient also takes insulin or oral sulfonylureas.
• 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.