Antidiabetic Drugs

Posts Tagged ‘Glucobay’

Alpha-glucosidase inhibitors also were popular in Europe prior to their introduction into the American market. At this time, they remain one of the most frequendy prescribed antidiabetic agents in Europe. Acarbose was the first agent in this class widely available in the United States. Alpha-glucosidase inhibitors act by blocking the absorption of carbohydrate from the gastrointestinal tract and are most effective in decreasing postprandial glucose elevation. The main advantage of these agents is that they act locally in the gut and are not systemic in their activity. Due to their nonsystemic activity, hypoglycemia is not associated with alpha-glucosidase inhibitors. The disadvantages, however, are greater in number.

Acarbose

Brand Name Drug: in Europe under the brand name Glucobay, in North America as Precose, and in Canada as Prandase

Acarbose and the other agents of this class have relatively weak antidiabetic activity, only reducing HgbA₁C by .5%-1% in most patients. Diarrhea and flatulence are the most common side effects, occurring in up to 40% of patients in most trials. Secondary to the high incidence of gastrointestinal distress, acarbose should be initiated slowly. It comes in 50-mg and 100-mg tablets, and it is currendy recommended that patients begin with 25 mg daily taken with a meal. Afterward, it can be advanced to 25 mg with two meals and slowly increased to a maximum of 300 mg/day. Acarbose should be taken with the first bite of the meal and the most benefit is achieved with doses > 150 mg/day. It is at these higher dosages that a recent study has shown reduction of HgbA₁C of 1%-2%. Unfortunately, the incidence of gastrointestinal side effects often precludes reaching these doses.

Miglitol

Brand Name Drug: Glyset

Recendy, miglitol, a new alpha-glucosidase inhibitor, was approved by the Food and Drug Administration. It reportedly has many of the gastrointestinal side effects that limit acarbose use. However, in preliminary studies, miglitol effectively lowered postprandial blood glucose and glycosylated hemoglobin levels.