Acarbose is a medication that's used together with a healthy diet and exercise to help control blood sugar in adults with Type 2 diabetes. It isn't as commonly used as other diabetes medications since it can lead to some unpleasant side effects like gas and diarrhea. But acarbose is less likely to cause hypoglycemia compared to other diabetes medications when used on its own. This medication is only available as the generic name acarbose since the brand name Precose has been discontinued.
Type 2 diabetes
Acarbose is an alpha-glucosidase inhibitor. It temporarily blocks a protein called alpha-glucosidase, which slows down the digestion of carbohydrates in your gut. As a result, your body will absorb less sugar from the foods that you eat. And this leads to lower blood sugar levels after you eat.
Source:Â DailyMed
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
Rare
Yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Not likely to cause weight gain, instead it might cause weight loss
Helps control blood sugar levels after you're eating
Low risk of low blood sugar when used alone
Can be used with other diabetes medications
Available as a lower-cost generic
Must be taken multiple times a day
Needs to be taken with meals
Side effects include excessive gas and diarrhea
Not recommended for people with severe kidney problems
Typically not considered a first-choice treatment option
Take acarbose with the first bite of each main meal so it can work properly.
If you're taking acarbose with other medications that can cause low blood sugar (e.g., insulin, sulfonylureas), carry glucose tablets with you at all times so that you can take them if your blood sugar drops. Products with sucrose, another form of sugar, might not work well to raise your blood sugar because acarbose will delay their digestion.
It's common to experience stomach side effects during the first few weeks of treatment with acarbose. These include stomach pain, excessive gas, and diarrhea. They should become less bothersome with time.
Talk to your provider before taking over-the-counter (OTC) products like Beano to help with gas. Some products contain alpha-glucosidase, the protein that acarbose blocks. If you take both, acarbose might not work as well at lowering your blood sugar.
Before making any changes to your medications, talk with your provider first. Certain medications (e.g., thiazides, corticosteroids, estrogens) have the potential to raise your blood sugar levels, and stopping them suddenly while taking acarbose could lead to low blood sugar levels.
Acarbose can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: Using insulin or sulfonylureas
When acarbose is used together with insulin or a sulfonylurea, your blood sugar can drop too low, which can be life-threatening. Signs of low blood sugar include fast heartbeat, sweating, pale skin, shakiness, confusion, and irritability. Make sure to carry glucose tablets at all times while you're on this medication, because products with sucrose (another form of sugar) won't work fast enough to raise your blood sugar.
Risk factors: Higher dose of medication | Women
In clinical trials, some people taking acarbose had changes in their liver labs. But these changes returned to normal after the medication was stopped. This is usually only seen when lab work is ordered. Make sure to get regular lab work done when your provider orders it. If you experience nausea, stomach pain, clay-colored stools, or yellowing of your skin or whites of your eyes, seek medical attention right away. These could be signs of liver problems.
Risk factors: Stress such as fever, trauma, infection, or surgery
Over time, acarbose might stop lowering your blood sugar. Sometimes this happens when your body is under stress. If this happens, you might need to stop acarbose and switch to insulin. Talk to your provider about how often you should check your blood sugar levels, and make sure to attend all of your follow-up appointments.
Starting dose: The typical starting dose is 25 mg three times daily by mouth taken with the first bite with each main meal.
Maintenance dose: The typical maintenance dose is 50 mg to 100 mg three times daily by mouth taken with the first bite with each main meal.
Your provider will adjust your dose based on whether you're having side effects and how well the medication is working to control your blood sugar levels.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Cirrhosis (liver damage)
Ulcers in the colon
Blockage in your gut
Gut problems associated with digestion or absorption issues
Conditions that worsen due to excessive gas in the gut
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American Diabetes Association. (n.d.). What Are My Options for Type 2 Diabetes Medications?
Centers for Disease Control and Prevention. (2022). How To Treat Low Blood Sugar (Hypoglycemia).
Chartwell RX, LLC. (2023). ACARBOSE tablet [package insert]. DailyMed.
ElSayed, N. A., et al. (2022). 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2023. Diabetes Care.
Lettieri, J. T., et al. (1998). Effects of beano on the tolerability and pharmacodynamics of acarbose. Clinical Therapeutics.
Rosak, C., et al. (1995). The effect of the timing and the administration of acarbose on postprandial hyperglycaemia. Diabetic Medicine: A Journal of the British Diabetic Association.
Schnell, O., et al. (2016). Acarbose reduces body weight irrespective of glycemic control in patients with diabetes: results of a worldwide, non-interventional, observational study data pool. Journal of Diabetes and Its Complications.
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