Glibenclamide Acarbose

An 87-year-old woman, who took acarbose, glibenclamide, and mannitol (for constipation), developed abdominal distention and loss of appetite. An X-ray showed distention of the small intestine, with pockets of small gas bubbles in the submucosal When her drugs... 

In a placebo-controlled study in six patients with type 2 diabetes, acarbose 300 mg/day for 7 days had no significant effect on the pharmacokinetics of a single dose of glibenclamide 5 mg (76). 

Gerard J, Lefebvre PJ, Luyckx AS. Glibenclamide pharmacokinetics in acarbose-treated type 2 diabetics. Eur J Clin Pharmacol 1984 27(2) 233-6. 

Gleiter CH, Schreeb KH, Freudenthaler S, Thomas M, Elze M, Fieger-Buschges H, Potthast H, Schneider E, Schug BS, Blume HH, Hermann R. Lack of interaction between thioctic acid, glibenclamide and acarbose. Br J Clin Pharmacol 1999 48(6) 819-25. 

A 58-year-old woman with type 2 diabetes took an overdose of metform in 55 g plus 100 mg of glibenclamide and 3.1 g of acarbose (58,131). She developed lactic acidosis and survived with hemodialysis. 

A 54-year-old woman with gestational diabetes was later found to be allergic to chromium, pollen, dust, penicillin, acarbose, and metformin (130). She was treated with diet and glibenclamide, but later required insulin. With Humulin N insulin she developed a wheal of 15 mm immediately after the injection, which resolved in a few hours. However, a painful itchy induration appeared 2-3 hours after the injection and lasted a few days. She had an immediate reaction to isophane insulin, with induration, but insulin lispro was well-tolerated. 

A 38-year-old woman was given insulin when glibenclamide and acarbose failed. Troglitazone 400 mg/day was added and increased to 800 mg/day 1 month later. After 2 months her liver function tests were normal, but she developed jaundice after 4 months. Total and direct bilirubin were 127 and 101 pmol/l and alanine transaminase was 34 pkat/l. After withdrawal of troglitazone her symptoms disappeared and her liver function tests normalized within several months. Metformin 1000 mg bd reduced her insulin requirement. Rosiglitazone 4 mg bd was added and her liver function tests remained normal for 10 months. 

Fig. 28. HbA levels during 6 months of treatment with acarbose or glibenclamide. (Source Folsch et al., 1990.)...

Hanefeld M, Haffner SM, Menschikowski M et al. Different effects of acarbose and glibenclamide on proinsulin and insulin profiles in people with type 2 diabetes. Diabetes Res Clin Pract 2002 55 221-227. 

Rosenthal JH, Mauersberger H. Effects on blood pressure of the alpha-glucosidase inhibitor acarbose compared with the insulin enhancer glibenclamide in patients with hypertension and type 2 diabetes mellitus. Clin Drug Invest 2002 22(10) 695-701. 

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