Acarbose plasma levels

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

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). 

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. ... 

An epileptic patient taking sodium valproate for 10 years had a 40% fall in his normally stable plasma levels from 67 to 40.5 mierograms/mL when acarbose was added. No other drugs were being taken. When the acarbose was stopped and then restarted, the valproate levels rose and then fell once again. The reason is not understood but the authors of the report suggest that the acarbose possibly reduces the absorption of valproate. This is an isolated report and its general importance is unknown, but it would seem prudent to be alert for any evidence of reduced effects if acarbose is added to valproate treatment. 

Some but not all studies have found that digoxin plasma levels can be markedly reduced by acarbose. Miglitol modestly reduced digoxin levels in healthy subjects, but no change was seen in diabetic patients. Voglibose does not appear to interact adversely with digoxin. 

Rabbits fed 30 mg/day acarbose showed reduced levels of plasma cholesterol, intermediate-density lipoprotein (IDL) and LDL (Kritchevsky et al., 1990) sudanophilia was reduced by 23% in rabbits fed 7.5 mg/day acarbose and by 43% in rabbits fed 15 or 30 mg/day (Kritchevsky et al., 1990). The decrease in total cholesterol was shown to be a consequence of a significant reduction in LDL cholesterol. Since HDL cholesterol concentrations remained unal-... 

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