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5 Acarbose Side Effects and How to Manage Them

Julie Adkison, PharmD, BCACP, CDCESAustin Ulrich, PharmD, BCACP
Published on November 17, 2023

Key takeaways:

  • Acarbose is an oral prescription medication. It belongs to the alpha-glucosidase inhibitor class and is used to treat Type 2 diabetes in adults. 

  • The most common acarbose side effects are gas, diarrhea, and abdominal pain. Let your healthcare provider know If these don’t improve over time.

  • Although rare, serious side effects such as liver damage may occur. Contact your healthcare provider right away if you notice symptoms such as dark-colored urine or yellowing of the eyes and skin.

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Type 2 diabetes treatment isn’t one-size-fits-all. And there are many options available, ranging from oral pills to injections. Of these, acarbose is an oral medication that’s less commonly prescribed. Yet, there are certain situations where it may be added on to your treatment regimen.

Acarbose is one of two medications that belong to a class known as alpha-glucosidase inhibitors. The other is miglitol, also used to treat Type 2 diabetes. Unlike certain other diabetes medications, they don’t typically affect your weight or cause hypoglycemia (low blood glucose). However, diarrhea and gas are common complaints from taking them.

So, what else can you expect from taking acarbose? We cover five acarbose side effects and how to manage them below. 

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1. Gas

Acarbose works by slowing down carbohydrate digestion in your stomach. This helps to prevent your blood glucose (sugar) from spiking after you eat. Unfortunately, this can also lead to gas.

Excessive gas is the most common acarbose side effect, especially with higher doses. Fortunately, this tends to improve over time. But in the meantime, your healthcare provider may have you eat a diet that’s lower in carbohydrates to lessen this effect. If this doesn’t help, they may have you take a lower acarbose dose.

Good to know: Unless directed otherwise, avoid taking an over-the-counter (OTC) remedy like Beano to help cut down on gas. This is because Beano may counteract the effects that acarbose has on carbohydrates.

2. Diarrhea

Along with gas, diarrhea is another common acarbose side effect. Similarly, diarrhea tends to improve over time and may be lessened with a lower carbohydrate diet. 

To reduce watery stools, it may also help to avoid fatty or fried foods that can make diarrhea worse. If needed, your healthcare provider or pharmacist may suggest an OTC treatment such as loperamide (Imodium A-D) for relief. Be sure to drink plenty of water to avoid becoming dehydrated.

Let your healthcare provider know If you develop worsening or severe diarrhea, which could indicate an infection or another cause. Warning signs include severe abdominal pain, fever, and blood or pus in your stools.

3. Abdominal pain

Mild abdominal pain is another common acarbose side effect. It’s most likely related to the gas produced by slowed carbohydrate digestion. Like the other side effects covered above, abdominal pain should also improve over time.

But if your abdominal pain worsens or doesn’t go away, contact your healthcare provider. While rare, it may be from gas inside the wall of the intestines. More on that later.

4. Liver test changes

Changes in liver function tests (LFTs) have been seen in a small number of people who take acarbose. LFTs are blood tests that measure how well your liver is functioning. When they’re elevated, there may be inflammation or tissue damage in your liver.

Liver test changes usually happen within the first 2 to 8 months of taking acarbose. For most people, this doesn’t cause any noticeable symptoms. In this case, your healthcare provider may find it during a routine follow up. Depending on the results, they may lower your dose or have you stop taking acarbose.

While rare, serious liver damage is possible. Symptoms may include dark-colored urine, extreme fatigue, and yellowing of the eyes and skin (jaundice). If you notice any of these, tell your healthcare provider right away.

5. Pneumatosis cystoides intestinalis

Pneumatosis cystoides intestinales (PCI) is a rare side effect of acarbose and other medications in its class. PCI is a condition where gas is inside the walls of your small or large intestine.

Some people with PCI don’t have any symptoms at all. Others have moderate abdominal pain and bloating. You may also notice blood or mucus in your stools.

Let your healthcare provider know if you have persistent abdominal pain that doesn’t get better with time. If they determine that PCI is the cause, they’ll have you stop taking acarbose. PCI treatment may depend on your symptoms.

When should you contact your healthcare provider about acarbose side effects?

If you have concerns about acarbose side effects, let your healthcare team know. Most side effects, including gas and diarrhea, will improve on their own over time. But if you can’t tolerate acarbose side effects and are thinking about stopping the medication, discuss that with your healthcare provider first.

You should also contact your healthcare team if any side effects are getting worse or won’t go away. This includes symptoms such as jaundice, dark-colored urine, or stools with blood or mucus, which can indicate a more serious problem that requires medical attention.

The bottom line

Common acarbose side effects include gas, diarrhea, and abdominal pain. These usually improve over time. While rare, more serious side effects, such as liver damage and pneumatosis cystoides intestinalis (PCI), are possible.

Let your healthcare team know if any side effects become too bothersome, get worse, or won’t go away. They may decide to lower your dose or switch you to a different diabetes medication. Always check with your healthcare team before stopping a medication on your own. 

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Why trust our experts?

Julie Adkison, PharmD, BCACP, CDCES
Julie Adkison, PharmD, BCACP, CDCES, is a clinical pharmacist specializing in ambulatory care practice and diabetes care and education. She has worked in a faculty position in family medicine for many years.
Alyssa Billingsley, PharmD
Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.
Austin Ulrich, PharmD, BCACP
Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

References

Bryant Ranch Prepack. (2023). Acarbose [package insert]

Lettieri, J. T., et al. (1998). Effects of beano on the tolerability and pharmacodynamics of acarbose. Clinical Therapeutics

View All References (2)

LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2021). Acarbose. National Institute of Diabetes and Digestive and Kidney Diseases.

McKinley, B. J., et al. (2022). Pneumatosis intestinalis induced by alpha-glucosidase inhibitors in patients with diabetes mellitus. Journal of Clinical Medicine.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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