Purchase Precose

Precose (acarbose)

THERAPEUTIC CLASS

Alpha-glucosidase inhibitor

DEA CLASS

RX

INDICATIONS

Adjunct to diet and exercise to improve glycemic control in adults w/ type 2 diabetes mellitus.

ADULT DOSAGE

Type 2 Diabetes Mellitus

Monotherapy or in Combination w/ Sulfonylureas, Insulin, or Metformin:
Initial:
25mg tid w/ 1st bite of each main meal; may also initiate at 25mg qd to minimize GI side effects and gradually increase to 25mg tid
Titrate: After reaching 25mg tid, dose may be adjusted at 4- to 8-week intervals, to 50 mg tid, and then further to 100mg tid in some patients
Maint Range: 50-100mg tid
Max:
≤60kg: 50mg tid
>60kg: 100mg tid

If no further reduction in postprandial glucose or HbA1c observed w/ 100mg tid, consider reducing dose

DOSING CONSIDERATIONS

Concomitant Medications
Patients Receiving Sulfonylureas or Insulin:
If hypoglycemia occurs, make appropriate dosage adjustments of these agents

Renal Impairment
SrCr >2mg/dL: Not recommended

ADMINISTRATION

Oral route

Take tid w/ 1st bite of each main meal

HOW SUPPLIED

Tab: 25mg, 50mg, 100mg

CONTRAINDICATIONS

Diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to it, chronic intestinal diseases w/ marked disorders of digestion or absorption, and conditions that may deteriorate from increased intestinal gas formation.

WARNINGS/PRECAUTIONS

Inhibits hydrolysis of sucrose to glucose and fructose; use oral glucose (dextrose) instead of sucrose (cane sugar) in treatment of mild to moderate hypoglycemia. Elevated serum transaminase levels, fulminant hepatitis, and hyperbilirubinemia reported. Reduce dose or d/c if elevated serum transaminases persist. A temporary loss of control of blood glucose may occur when exposed to stress; temporary insulin therapy may be necessary. Monitoring of glycemic control w/ 1,5-AG assay is not recommended; use alternative methods to monitor for glycemic control. Pneumatosis cystoides intestinalis reported; d/c and perform appropriate diagnostic imaging if this is suspected. Reduce dose temporarily or permanently if strongly distressing symptoms develop in spite of adherence to the diabetic diet.

ADVERSE REACTIONS

Flatulence, diarrhea, abdominal pain.

DRUG INTERACTIONS

See Dose Modification. Closely observe for loss of blood glucose control w/ thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid. Intestinal adsorbents (eg, charcoal) and digestive enzyme preparations containing carbohydrate-splitting enzymes (eg, amylase, pancreatin) may reduce effect; avoid concomitant use. May affect digoxin bioavailability; may require dose adjustment of digoxin.

PREGNANCY AND LACTATION

Category B, not for use in nursing.

MECHANISM OF ACTION

α-glucosidase inhibitor; competitively and reversibly inhibits pancreatic α-amylase and membrane-bound intestinal α-glucoside hydrolase enzymes.

PHARMACOKINETICS

Absorption: Active Drug: Bioavailability (<2%); Tmax=approx 1 hr. Metabolism: GI tract by intestinal bacteria and digestive enzymes; 4-methylpyrogallol derivatives (major metabolites). Elimination: Urine (<2%), feces (51%, unabsorbed); T1/2=approx 2 hrs.

ASSESSMENT

Assess for hypersensitivity to the drug, renal dysfunction, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to it, chronic intestinal diseases w/ marked disorders of digestion or absorption, conditions that may deteriorate from increased intestinal gas formation, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for signs/symptoms of hypoglycemia, pneumatosis cystoides intestinalis, and other adverse reactions. Monitor FPG, HbA1c, LFTs, and renal function. Monitor serum transaminases every 3 months for 1st yr, then periodically.

PATIENT COUNSELING

Instruct to take tid at the start of each main meal. Inform about importance of adhering to dietary instructions, a regular exercise program, and regular testing of urine and/or blood glucose. Counsel about risks, signs/symptoms, and treatment of hypoglycemia, and conditions that predispose to its development. Instruct to have readily available source of glucose (dextrose, D-glucose) to treat symptoms of low blood sugar. Inform that side effects (GI effects such as flatulence, diarrhea, abdominal discomfort) usually develop during the 1st few weeks of therapy and generally diminish in frequency and intensity w/ time.

STORAGE

≤25°C (≤77°F). Protect from moisture.

Acarbose is used along with a proper diet and exercise program to control high blood sugar in people with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. Acarbose works by slowing the breakdown of starch (carbohydrates) from the food you eat into sugar, so that your blood sugar level does not rise as much after a meal.

Acarbose may be used with other medications (e.g., insulin, metformin, sulfonylureas such as glipizide) to control diabetes because they work in different ways.

How to use Precose

Take this medication by mouth, usually 3 times a day at the start (with the first bites) of each main meal or as directed by your doctor.

The dosage is based on your medical condition, weight, and response to therapy. Your dose may be gradually increased to determine the most effective dose for you. The manufacturer recommends that you do not take more than 300 milligrams per day.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

For best results, continue to eat a proper diet, exercise regularly, and check your blood sugar regularly as directed by your doctor.

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