Alpha glucosidase inhibitors

Holman RR. (1998) Assessing the potential for alpha-glucosidase inhibitors in prediabetic states. Diabetes Res Clin Pract 40 21-25. 

Kawabata J, Mizuhata K, Sato E, Nishioka T, Aoyama Y, Kasai T. (2003) 6-hydroxyflavonoids as alpha-glucosidase inhibitors from marjoram (Origanum majorana) leaves. Biosci Biotechnol Biochem 67 445-447. 

Insulin Exenatide is not a substitute for insulin in insulin-requiring patients. Do not use exenatide in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. The concurrent use of exenatide with insulin, thiazolidinediones, D-phenylalanine derivatives, meglitinides, or alpha-glucosidase inhibitors has not been studied. 

Voglibose is considered to be an improvement over the other two alpha-glucosidase inhibitors both in terms of potenty and side effect profile. 

II.f.2.1. Oral hypoglycaemic agents. There are now five groups of orally active drugs available to lower blood glucose in clinical practice (Table 2). These are sulphonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and the incretin derivatives. 

Alpha glucosidase inhibitors mainly reduced postprandial blood glucose and has a mean lowering of initial HbAlc of 0.5-1.0%. The major side effects are abdominal discomfort. Hence it is advised to begin with a low dose (25-50 mg) at the start of meals and increase slowly up to a dose of 100 mg three times daily, as judged by the patient s response. 

Alpha-Glucosidase Inhibitor Chemical Structure Oral Dose... 

Alpha-glucosidase inhibitors are infrequently prescribed in the United States because of their prominent gastrointestinal adverse effects and relatively minor glucose-lowering benefit. 

Miglitol (Glyset) [Hypoglycemic/Alpha Glucosidase Inhibitor]... 

Alpha-glucosidase inhibitors are competitive inhibitors of la-glucosidases, enzymes that are located in the brush border of epithelial cells, mainly in the upper half of the small intestine. The enzymes degrade complex carbohydrates into monosaccharides, which are absorbed. The alpha-glucosidase inhibitors bind reversibly in a dose-dependent manner to the oligosaccharide binding site of... 

The alpha-glucosidase inhibitors (polyhexose mimick-ers) in use are acarbose (rINN) (2 1), miglitol (rINN) (5-7), and voglibose (rINN), which is 20 times more potent (8). They have been reviewed (9). 

When acarbose is combined with insulin, the greatest effects are seen with regimens that involve only once- or twice-daily administration. The alpha-glucosidase inhibitors seem to be less effective when they are combined with intensive insulin therapy (35). In combination with insulin or oral hypoglycemic drugs the frequency of hypoglycemic episodes can increase sucrose or higher carbohydrates are reported to be less effective, which can be understood from the mechanism of action. 

Non-digestable sugar substitutes and alpha-glucosidase inhibitors should probably not be used in combination. 

Mitrakou A, Tountas N, Raptis AE, Bauer RJ, Schulz H, Raptis SA. Long-term effectiveness of a new alpha-glucosidase inhibitor (BAY ml099—miglitol) in insulin-treated type 2 diabetes mellitus. Diabet Med 1998 15(8) 657-60. 

Lebovitz HE. Alpha-glucosidase inhibitors as agents in the treatment of diabetes. Diabetes Rev 1998 6 132 15. 

Hasegawa T, Yoneda M, Nakamura K, Ohnishi K, Harada H, Kyouda T, Yoshida Y, Makino I. Long-term effect of alpha-glucosidase inhibitor on late dumping syndrome. J Gastroenterol Hepatol 1998 13(12) 1201-6. 

Scheen AJ, Lefebvre PJ. Potential pharmacokinetics interference between alpha-glucosidase inhibitors and other oral antidiabetic agents. Diabetes Care 2002 25(l) 247-8. 

Kleist P, Ehrlich A, Suzuki Y, Timmer W, Wetzelsberger N, Lucker PW, Fuder H. Concomitant administration of the alpha-glucosidase inhibitor voglibose (AO-128) does not alter the pharmacokinetics of glibenclamide. Eur J Clin Pharmacol 1997 53(2) 149-52. 

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