Acarbose absorption

Acarbose is a nonabsorbable a-glucosidase inhibitor which blocks the digestion of starch, sucrose, and maltose. The digestion of complex carbohydrates is delayed and occurs throughout the small intestine rather than in the upper part of the jejunum. Absorption of glucose and other monosaccharides is not affected. Acarbose is adrninistered orally three times a day and chewed with the first mouthful of food. 

Acarbose and Miglitol These agents are specific inhibitors of intestinal glucosidases and reduce the conversion of sucrose and starch to glucose. Their main effect is a delay, not a complete inhibition, of the absorption of carbohydrates. Postprandial blood sugar excursions are effectively reduced. Because a small portion of the carbohydrates enters the colon, their microbial degradation frequently causes flatulence or... 

The a-glucosidase inhibitors, acarbose (Precose) and miglitol (Glyset), lower blood sugar by delaying die digestion of carbohydrates and absorption of carbohydrates in the intestine. 

Acarbose is an intestinal a-glucosidase inhibitor that delays digestion and absorption of starch and sucrose. It is used in diabetes mellitus and is contraindicated in inflammatory bowel disease. 

Acarbose Precose) is an ohgosaccharide derivative that has a higher affinity for the a- glucosidase enzymes than do other dietary oUgosaccharides. Systemic absorption of acarbose is very low ( 2%), with most being broken down in the intestine to several metabolites. About half of the orally administered acarbose is excreted unchanged in the feces, while the remainder, some of which is systemically absorbed, is renally excreted. Acarbose may be associated with hepatotoxicity in rare instances. 

Contraindications Chronic intestinal diseases associated with marked disorders of digestion or absorption, cirrhosis, colonic ulceration, conditions that may deteriorate as a result of increased gas formation in the intestine, diabetic ketoacidosis, hypersensitivity to acarbose, inflammatory bowel disease, partial intestinal obstruction or predisposition to intestinal obstruction, significant renal dysfunction (serum creatinine level greater than 2 mg/dl)... 

Geriatric Considerations-Summary G1 effects maybe even more prevalent in older adults. Not associated with hypoglycemia when used as monotherapy. If hypoglycemia occurs in a patient taking acarbose, use oral glucose for treatment as acorbose may prevent the absorption of other complex carbohydrates. Avoid In older adults with SCr> 2 mg/dl. 

Acarbose can reduce plasma concentrations of digoxin by impairing its absorption (70). 

In a randomized, crossover study in healthy men, acarbose 100-200 mg reduced the AUC and Cmax of digoxin and prolonged its tmax, consistent with reduced absorption (73). However, in another study acarbose 50 mg tds for 12 days had no significant effect on the pharmacokinetics of a single oral dose of digoxin 0.75 mg (74). 

Acarbose reduces the absorption of metformin (79), as does miglitol (77). 

Miura T, Ueno K, Tanaka K, Sugiura Y, Mizutani M, Takatsu F, Takano Y, Shibakawa M. Impairment of absorption of digoxin by acarbose. J Clin Pharmacol 1998 38(7) 654-7. 

The different mechanisms of action of the various classes of hypoglycemic drugs makes combined therapy feasible the sulfonylureas and meglitinides stimulate insulin production by different mechanisms, the biguanides reduce glucose production by the liver and excretion from the liver, acarbose reduces the absorption of glucose from the gut, and the thiazolidinediones reduce insulin resistance in fat. It is not necessary to wait until the maximal dose of... 

Metformin can be effectively combined with miglitol (SEDA-25, 514) but metformin may accumulate in the gastrointestinal wall, and the combination of metformin with acarbose or miglitol may reduce the absorption of metformin (136,137). 

Acarbose is a glucopyranose derivative that acts by inhibiting intestinal a-gluco-sidase. This delays carbohydrate absorption and reduces the postprandial (1.5 hours after food) blood glucose levels and is used in combination with other sulfonyl-ureas. Acarbose may cause GI disturbances, flatulence, abdominal distortion, diarrhea, and pain. Acarbose should be avoided during pregnancy, as it affects the fetus. Acarbose is contraindicated in inflammatory bowel disease and hepatic dysfunction. 

Neomycin Neomycin interferes with the absorption of digoxin, methotrexate, vitamins, some penicillins, acarbose, and oral contraceptives. 

I a-Giucosidase Inhibitors Acarbose -2 Slows absorption of nutrients from jejunum by inhibiting a-glucosidase taken with meais... 

Acarbose is an inhibitor of a-glucosidase (localized in the brush border of intestinal epithelium), which liberates glucose from disaccharides. It retards breakdown of carbohydrates, and hence absorption of glucose. Owing to increased fermentation of carbohydrates by gut bacteria, flatulence and diarrhea may develop. Miglitol has a similar effect but is absorbed from the intestine. 

DIGOXIN ANTIDIABETIC DRUGS-ACARBOSE Acarbose may 1 plasma levels of digoxin Uncertain possibly 1 absorption of digoxin Monitor digoxin levels watch for 1 levels... 

The gastrointestinal tract is the main site of action of acarbose, which is metabolized exclusively within the gastrointestinal tract, principally by intestinal bacteria this process may be adversely affected by antibiotics that alter the intestinal bacterial flora. Acarbose affects the absorption of some drugs (e.g. digoxin). 

ACARBOSE H2 RECEPTOR BLOCKERS -RANITIDINE 1 blood levels of ranitidine Possibly due to 1 absorption of ranitidine Be aware... 

ACARBOSE PANCREATIN Theoretical risk of 1 efficacy of acarbose 1 absorption Watch for poor response to acarbose monitor capillary blood glucose closely... 

---