Generic Name

Miglitol

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Classification

FDA Approved Indications

• Management of type 2 diabetes mellitus as an adjunct to diet and exercise

Mechanism of Action

Miglitol inhibits intestinal alpha-glucosidases, enzymes responsible for breaking down complex carbohydrates into monosaccharides, thereby delaying carbohydrate digestion and absorption to reduce postprandial blood glucose levels.

Dosage and Administration

Adult: Initially 25 mg once daily at the first bite of the main meal. Dosage can be titrated up to 50 mg three times daily based on glycemic response.

Pediatric: Not approved for use in pediatric patients.

Geriatric: Use with caution; dose adjustments may be necessary based on renal function.

Renal Impairment: Renal function should be assessed prior to initiation and periodically; dose adjustment may be necessary for renal impairment.

Hepatic Impairment: Data limited; use with caution in hepatic impairment.

Pharmacokinetics

Absorption: Poorly absorbed from gastrointestinal tract; systemic absorption is minimal.

Distribution: Minimal systemic distribution due to poor absorption.

Metabolism: Not significantly metabolized.

Excretion: Excreted unchanged primarily via the urine.

Half Life: Approximately 2 hours in plasma, but not relevant as systemic absorption is minimal.

Contraindications

• Impaired renal function (eGFR < 25 mL/min/1.73 m²)
• Inflammatory bowel disease
• Chronic intestinal disease associated with defect in carbohydrate absorption

Precautions

• Use cautiously in patients with hepatic impairment, intestinal disorders, or colon ulceration; monitor blood glucose levels closely to avoid hypoglycemia, especially when used with other antidiabetics.

Adverse Reactions - Common

• Flatulence (Common)
• Diarrhea (Common)
• Abdominal pain (Uncommon)

Adverse Reactions - Serious

• Hepatic dysfunction (Rare)

Drug-Drug Interactions

• Other antidiabetic agents (additive hypoglycemia risk)
• Potassium chloride (can cause GI upset)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication with the first bite of each main meal.
• Watch for signs of hypoglycemia and hyperglycemia.
• Maintain regular blood glucose testing.
• Report any unusual side effects, such as severe abdominal pain or hepatic symptoms.

Special Considerations

Black Box Warnings:

• None

Genetic Factors: None known.

Lab Test Interference: May cause elevated liver enzymes; monitor as indicated.

Overdose Management

Signs/Symptoms: Severe hypoglycemia, gastrointestinal discomfort.

Treatment: Discontinue drug, provide supportive care, and administer glucose orally or IV as needed.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable for at least 2 years if stored properly.