Nurses Compass
Drug Guide
Acarbose
Classification
Therapeutic: Antidiabetic agent
Pharmacological: Alpha-glucosidase inhibitor
FDA Approved Indications
- Type 2 diabetes mellitus to improve glycemic control
Mechanism of Action
Inhibits alpha-glucosidase enzymes in the intestinal brush border, delaying carbohydrate digestion and absorption, thereby reducing postprandial blood glucose levels.
Dosage and Administration
Adult: Start with 25 mg three times daily at the beginning of each meal. Dosage may be increased based on response and tolerability, up to 100 mg three times daily.
Pediatric: Not typically used in children.
Geriatric: Use with caution; monitor for adverse effects.
Renal Impairment: Adjust dose based on creatinine clearance; usually not recommended if severe impairment.
Hepatic Impairment: Use with caution; limited data available.
Pharmacokinetics
Absorption: Minimal systemic absorption.
Distribution: Not significantly distributed into tissues.
Metabolism: Primarily through hydrolysis in the intestine.
Excretion: Excreted unchanged in feces; minimal renal excretion.
Half Life: Not applicable due to minimal systemic absorption.
Contraindications
- Innhalation disorders such as intestinal obstruction, inflammatory bowel disease, colonic ulceration.
- Hypersensitivity to acarbose.
Precautions
- Use cautiously in patients with hepatic disease, gastrointestinal conditions, or renal impairment. Hypoglycemia can occur if used with other antidiabetic agents—treat with glucose, not sucrose.
Adverse Reactions - Common
- Gas (flatulence) (Common)
- Abdominal pain (Common)
- Diarrhea (Common)
Adverse Reactions - Serious
- Hepatotoxicity (rare) (Rare)
- Hypoglycemia (when combined with other agents) (Uncommon)
- Elevated liver enzymes (Uncommon)
Drug-Drug Interactions
- Metformin—may increase risk of lactic acidosis when combined.
Drug-Food Interactions
- Sucrose—should avoid due to hypoglycemia risk during overdose or missed dose.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood glucose levels regularly. Liver function tests periodically.
Diagnoses:
- Risk for unstable blood glucose levels.
- Potential for altered gastrointestinal motility.
Implementation: Administer with the first bite of each main meal. Educate patient on signs of hypoglycemia and the importance of adhering to dietary recommendations.
Evaluation: Assess postprandial blood glucose levels to determine therapeutic effectiveness.
Patient/Family Teaching
- Take medication exactly as prescribed with meals.
- Report signs of gastrointestinal intolerance.
- Watch for hypoglycemia; treat with glucose, not sucrose.
- Maintain a consistent diet.
Special Considerations
Black Box Warnings:
- None specific.
Genetic Factors: None known.
Lab Test Interference: May cause elevated liver enzymes, requiring monitoring.
Overdose Management
Signs/Symptoms: Gastrointestinal symptoms such as diarrhea, flatulence, abdominal pain; hypoglycemia if used with other agents.
Treatment: Discontinue medication; treat hypoglycemia with glucose (not sucrose).
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable for up to 2 years if storage conditions are maintained.