Promethazine Acarbose

A 73-year-old man with diabetic gangrene who had used insulin and acarbose 300 mg/day for 15 months developed ileus with abdominal pain and vomiting after he took PL granules (containing salicylamide, paracetamol, anhydrous caffeine, and promethazine methylene disalicylate) for a common cold (51). The ileus subsided after acarbose and the other drugs were withdrawn. 

Although the ileus in this case was not clearly related to the use of acarbose, the combination of acarbose, which can cause ileus, with the other drugs that the patient was taking, may have caused it. The anticholinergic effect of promethazine methylene disalicylate may have contributed. 

Neomycin may increase the efficacy and the gastrointestinal adverse effects of acarbose. There is some indirect evidence that acarbose with alcohol may increase the hepatotoxicity of paracetamol (acetaminophen). Parafytic ileus has been reported in a Japanese patient treated with acarbose and promethazine, an an-timuscarinic drug. 

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