Metformin acarbose combinations

Other combination options Metformin or a Sulfonylurea plus Acarbose/Miglitol, or Pioglitazone/ Rosiglitazone or Repaglinide (with metformin), or Insulin... 

Hanefeld M, Bar K. Efficacy and safety of combined treatment of type 2 diabetes with acarbose and metformin. Diabetes Stoffwechsel 1998 7 186-90. 

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). 

There are three conditions for the clinical use of metformin as a glucose-lowering agent in patients with NIDDM (1) as a primary drug, (2) in combination with other oral hypoglycaemic agents such as sulphonylureas and acarbose, and (3) together with insulin after secondary sulphonylurea failure. 

For a review, see Sachse etal. (1982). Combining acarbose with sulphonylurea or metformin or insulin may lead to hypoglycaemia, although acarbose itself will not produce hypoglycaemia (doses have to be corrected). The effect of acarbose may be reduced by antacids, cholestyramine, pancreatic enzymes and adsorbants. Plasma levels of vitamin B6 increased, and vitamin A concentrations decreased with acarbose (Couet et al., 1989). 

Rosiglitazone has been studied in combination with acarbose, digoxin, metformin, nifedipine, ranitidine, warfarin, and oral contraceptives [67,72] There have been no clinically significant effects on the pharmacokinetics of any of these agents in combination with rosiglitazone. 

Another study in 19 diabetic patients given acarbose 50 or 100 mg three times daily and metformin 500 mg twice daily, also found that acarbose lowered metformin levels (AUC reduced by 12 to 13%, maximum plasma levels reduced by 17 to 20%). Nevertheless, the drug combination reduced the postprandial glucose concentration at 3 hours by 15% mote than metformin alone. Similarly, the manufacturer notes that, in a study in healthy subjects, miglitol 100 mg three times daily for 7 days reduced the AUC and maximum level of a single 1-g dose of metformin by 12% and 13%, respectively, although this difference was not statistically significant. ... 

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