Acarbose

FDA label

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Titration Adjust at 4–8 week intervals based on 1-hour postprandial glucose or HbA1c and tolerance.

Renal Undefined

Hepatic Contraindicated in cirrhosis.

Maximum dose is weight-based: ≤60 kg → 50 mg TID; >60 kg → 100 mg TID.

Instructions

• Take three times daily at the start (with the first bite) of each main meal.
• Start at a low dose (25 mg) and titrate gradually to minimize GI side effects.
• Adhere to the prescribed diabetic diet to limit intestinal side effects.
• Only patients >60 kg should be titrated above 50 mg TID.

Contraindications

• Diabetic ketoacidosis
• Cirrhosis
• Inflammatory bowel disease, colonic ulceration, or partial/predisposition to intestinal obstruction
• Chronic intestinal disease with marked disorders of digestion or absorption
• Conditions that may deteriorate from increased intestinal gas formation

Cautions

• Dose-related elevated serum transaminases (greater risk in patients ≤60 kg) — monitor
• Common GI symptoms: flatulence, diarrhea, abdominal pain
• Rare pneumatosis cystoides intestinalis
• Hypoglycemia risk when combined with a sulfonylurea or insulin

Adverse reactions

• GI (most common): flatulence (74%), diarrhea (31%), abdominal pain (19%)
• Elevated serum transaminases; postmarketing: fulminant hepatitis, skin reactions, edema, ileus/subileus, jaundice/hepatitis, thrombocytopenia

Pregnancy Pregnancy Category B; no adequate human studies; use only if clearly needed (insulin generally preferred in pregnancy).

Lactation Should not be given to nursing women (present in rat milk; human excretion unknown).