Voglibose

Agents include acarbose, miglitol and voglibose. Only bacterial breakdown products of acarbose are absorbed which are then rapidly eliminated by the kidneys. Adverse events mainly consist of gastrointestinal complaints which in rare cases can be confused with ileus. Some hepatotoxicity has been reported. 

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

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). 

Voglibose and acarbose have been compared in 32 patients insufficiently treated by diet in an open crossover study (17). The metabolic results were identical. There were fewer adverse reactions in those who took voglibose. There was increased flatulence with acarbose in 96% and with voglibose in 57% abdominal distension was reported in 17 and 10% respectively. 

In a comparison of voglibose and acarbose in 21 in-patients with type 2 diabetes who took part in a randomized crossover study of acarbose 150 mg/day and voglibose 0.9 mg/day, there was marked interindividual variation in response (18). For both drugs efficacy was better in those with gastrointestinal adverse effects, such as abdominal distention and flatulence. 

In 36 Japanese patients who were relatively lean but had excess abdominal fat, glibenclamide and voglibose caused loss of weight and abdominal fat (37). The loss of abdominal fat was related to glycemic control. The ratio of subcutaneous to abdominal fat shifted toward subcutaneous fat only in those who took voglibose. Both voglibose and glibenclamide improved insulin sensitivity and the acute response to insulin. 

In one study there was no interaction of voglibose with digoxin (75). 

In a double-blind, crossover study in 12 healthy men, voglibose 5 mg tds for 8 days had no significant effect on the pharmacokinetics of a single dose of glibenclamide 1.75 mg (78). 

Acarbose may increase the availability of warfarin (81). However, neither miglitol (82) nor voglibose (83) has any effect. 

Matsumoto K, Yano M, Miyake S, Ueki Y, Yamaguchi Y, Akazawa S, Tominaga Y. Effects of voglibose on glycemic excursions, insulin secretion, and insulin sensitivity in non-insulin-treated NIDDM patients. Diabetes Care 1998 21(2) 256-60. 

Vichayanrat A, Ploybutr S, Tunlakit M, Watanakejorn P. Efficacy and safety of voglibose in comparison with acarbose in type 2 diabetic patients. Diabetes Res Clin Pract 2002 55(2) 99-103. 

Fujisawa T, Ikegami H, Inoue K, Kawabata Y, Ogihara T. Effect of two a-glucosidase inhibitors, voglibose and... 

Kageyama S, Nakamichi N, Sekino H, Fujita H, Nakano S. Comparison of the effects of acarbose and voglibose on plasma glucose, endogenous insulin sparing, and gastrointestinal adverse events in obese subjects a randomized, placebo-controlled, double-blind, three-way crossover study. Curr Ther Res Clin Exp 2000 61 630-45. 

Taira M, Takasu N, Komiya I, Taira T, Tanaka H. Voglibose administration before the evening meal improves nocturnal hypoglycemia in insulin-dependent diabetic patients with intensive insulin therapy. Metabolism... 

Takami K, Takeda N, Nakashima K, Takami R, Hayashi M, Ozeki S, Yamada A, Kokubo Y, Sato M, Kawachi S, Sasaki A, Yasuda K. Effects of dietary treatment alone or diet with voglibose or glyburide on abdominal adipose tissue and metabolic abnormalities in patients with newly diagnosed type 2 diabetes. Diabetes Care 2002 25(4) 658-62. 

Nagai Y, Hayakawa T, Abe T, Nomura G. Are there different effects of acarbose and voglibose on serum levels of digoxin in a diabetic patient with congestive heart failure Diabetes Care 2000 23(11) 1703. 

Kusumoto M, Ueno K, Fujimura Y, Kameda T, Mashimo K, Takeda K, Tatami R, Shibakawa M. Lack of kinetic interaction between digoxin and voglibose. Eur J Clin Pharmacol 1999 55(l) 79-80. 

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. 

A 76-year-old man who had taken glibenclamide for 2 weeks, having switched from voglibose, developed pneumonitis a lymphocyte stimulation test was positive for glibenclamide (32). 

A 67-year-old man took pioglitazone 30 mg/day after having taken glibenclamide 2.5 mg/day for 10 years and voglibose 0.6 mg/day for 5 years (104). His liver function was normal before and during 6 months of pioglitazone therapy, but at 7 months he had abnormal liver function tests (total bilirubin 10 pmol/l, aspartate... 

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