Alpha-Glucosidase inhibitors. (Medication Update).Mode of Action The alpha-glucosidase inhibitors are competitive, reversible inhibitors of alpha-amylase from the pancreas and alpha-glucosidase, which is found in the brush border of the small intestine. This inhibition results in reduced postprandial postprandial /post·pran·di·al/ (-pran´de-al) occurring after a meal. post·pran·di·al adj. Following a meal, especially dinner. increases in blood glucose levels by delaying the digestion of dietary carbohydrates. Contraindications known hypersensitivity to the particular alpha-glucosidase inhibitors, or components of their formulations. Significant renal dysfunction, as evidenced by a serum creatinine >2mg/dL. Cirrhosis. Diabetic ketoacidosis. Inflammatory bowel disease inflammatory bowel disease n. Abbr. IBD Any of several incurable and debilitating diseases of the gastrointestinal tract characterized by inflammation and obstruction of parts of the intestine. , intestinal obstruction or predisposition to obstruction, colon ulceration, or other disorders of digestion or absorption. Pregnancy Category: B. Adverse Effects Gastrointestinal effects, including abdominal pain (11.7%-21%), diarrhea (28.7%-33%), and flatulence (41.5%-77%), are very common. They may be reduced by slow titration of the dose, and generally improve as treatment is continued. Drug-Drug Interactions May reduce serum digoxin digoxin: see digitalis. concentrations. Digestive enzymes and intestinal adsorbents, such as charcoal, should not be taken at the same time as the alpha-glucosidase inhibitors, as they will decrease the efficacy of the alphaglucosidase inhibitors. Miglitol decreases the bioavailability of propranolol propranolol /pro·pran·o·lol/ (-pran´o-lol) a ß, used as the hydrochloride salt in the treatment and prophylaxis of certain cardiac disorders, the treatment of tremors and of inoperable pheochromocytoma, and the prophylaxis of migraine. and ranitidine ranitidine /ra·ni·ti·dine/ (rah-ni´ti-den) a histamine H2 receptor antagonist, used as the hydrochloride salt to inhibit gastric acid secretion in the treatment of gastric and duodenal ulcer, gastroesophageal reflux disease, and . Drug-Food Interactions The COX-2 inhibitors, especially in higher doses, should generally be taken with meals to reduce GI upset. Recommended Doses Acarbose acarbose /acar·bose/ (a´kahr-bos) an a inhibitor used in treatment of type 2 diabetes mellitus. acarbose, n brand name: Precose, Prandase; drug class: (precose): Starting dose, 25 mg TID tid 3 times a day , usual dose range, 50-100 mg TID. Should be taken with the first bite of each meal. Miglitol (glyset): Starting dose, 25 mg TID, usual dose range, 50-100 mg TID. Should be taken with the first bite of each meal. Dosage Forms Available Acarbose: 50 mg and 100 mg tablets. Manufacturers Miglitol: 25 mg, 50 mg, and 100 mg tablets. Acarbose: Bayer. Other Points of Interest Miglitol: Bayer. While use of the alpha-glucosidase inhibitors alone is not associated with hypoglycemia, if they are used in combination with other antidiabetic medications, hypoglycemia may occur. This should be treated by administering oral dextrose dextrose: see glucose. . Sucrose (table sugar or candy bars) will not reverse the hypoglycemia due to the pharmacologic effects of the alphaglucosidase inhibitors. References (1.) Hutchison TA, Shahan DR, Anderson ML (eds): DRUGDEX System. MICROMEDEX, mc, Englewood, Colo. (Edition expires 12/2000) (2.) Hebel SK, Katstrup EK (eds): Drug Facts and Comparisons. St. Louis, Mo. 2001 |
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