Rosiglitazone Acarbose

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

A 49-year-old man with pre-existing hepatic pathology took rosiglitazone 4 mg/day for 2 months and 8 mg/day for 5 months (114). He developed a bull face and then edema of the eyelids and neck. He had anorexia and nausea. His serum sodium was 110 mmol/1, potassium 3.3 mmol/1, chloride 81 mmol/1, cholesterol 21 mmol/1, triglycerides 33 mmol/1, and his liver enzymes were raised. Rosiglitazone was withdrawn and he was given saline and potassium, acarbose for his diabetes, spironolactone 200 mg/day for edema, and atorvastatin 10 mg/ day for hyperlipidemia. He improved over 3 weeks. 

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. 

Other combination options Metfomin or a sulfonylurea plus pioglitazone/rosiglitazone or acarbose/miglitol Metfomin plus Nateglinide or repaglinide or insulin or insulin analog (as mono—or combination therapy) ... 

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. 

A study in 16 healthy subjects found that acarbose 100 mg three times daily for a week slightly reduced the absorption of a single 8-mg oral dose of rosiglitazone (AUC reduced by 12%), but this was not considered to be clinically relevant. ... 

Cimetidine appears to reduce the clearance of metformin, and may have contributed to a case of metformin-associated lactic acidosis. Cimetidine did not alter repaglinide pharmacokinetics, and ranitidine did not alter pioglitazone or rosiglitazone pharmacokinetics. Acarbose did not alter ranitidine pharmacokinetics, but miglitol decreased the AUC of ranitidine by 60%. 

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