Precose (acarbose) is an oral alpha-glucosidase inhibitor medication specifically designed to manage type 2 diabetes by targeting postprandial hyperglycemia. It works locally within the small intestine to delay the digestion of complex carbohydrates and disaccharides, resulting in a slower and more controlled rise in blood glucose levels after meals. This mechanism offers a complementary approach to diabetes management, particularly for patients who experience significant glucose spikes following carbohydrate intake. It is often used in combination with other antidiabetic agents or as monotherapy when metformin is not tolerated or contraindicated.

Features

• Active pharmaceutical ingredient: Acarbose
• Drug class: Alpha-glucosidase inhibitor
• Available in oral tablet formulations (25 mg, 50 mg, 100 mg)
• Works locally within the lumen of the small intestine
• Minimal systemic absorption
• Requires concomitant dietary modification with complex carbohydrates

Benefits

• Specifically targets and reduces postprandial blood glucose excursions, smoothing out the daily glucose profile.
• Lowers glycosylated hemoglobin (HbA1c) levels as part of a comprehensive diabetes management plan.
• Not associated with weight gain and may contribute to modest weight loss or weight neutrality.
• Does not cause hypoglycemia when used as a monotherapy, as its mechanism is glucose-dependent.
• Minimal systemic effects due to its primarily local action within the gastrointestinal tract.
• Provides a therapeutic option for patients who cannot tolerate first-line metformin therapy.

Common use

Precose is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is most effective for individuals whose diets are high in complex carbohydrates and who experience problematic post-meal glucose spikes. It can be used as monotherapy or in combination with other oral antidiabetic agents (such as sulfonylureas or metformin) or insulin when glycemic control is not achieved by diet, exercise, or a single agent alone. Its primary role is to flatten the postprandial glucose curve.

Dosage and direction

The dosage of Precose is highly individualized. Therapy should be initiated with a low dose to minimize gastrointestinal side effects and titrated upward based on tolerability and effectiveness.

• Initial Dose: 25 mg administered orally three times daily with the first bite of each main meal.
• Titration: After 4 to 8 weeks of treatment, the dosage may be increased to 50 mg three times daily. Further titration to the maximum recommended dose may occur at subsequent 3-month intervals based on 1-hour postprandial glucose or HbA1c levels.
• Maintenance Dose: The usual maintenance dose is 50 mg or 100 mg three times daily.
• Maximum Dose: 100 mg three times daily for patients weighing > 60 kg (132 lbs). For patients weighing ≤ 60 kg, the maximum dose is 50 mg three times daily.
• Administration: It is critical that the tablet be taken with the first bite of the meal. Taking it before or after the meal significantly reduces its efficacy.

Precautions

• Gastrointestinal Effects: Due to its mechanism of action, Precose commonly causes gastrointestinal symptoms such as flatulence, diarrhea, and abdominal pain, especially upon initiation. These effects often diminish over time with continued use.
• Renal Impairment: Plasma concentrations of acarbose may be significantly elevated in patients with severe renal impairment (creatinine clearance < 25 mL/min). Therefore, Precose is contraindicated in this patient population.
• Hepatic Impairment: Use with caution in patients with significant liver disease, as acarbose metabolism may be altered, and elevated serum transaminase levels have been reported.
• Hypoglycemia: While monotherapy does not cause hypoglycemia, the risk increases significantly when Precose is used in combination with a sulfonylurea or insulin. It is important to note that oral glucose (dextrose) must be used to treat hypoglycemia in these patients, as sucrose (table sugar) hydrolysis will be inhibited by acarbose and its absorption will be delayed.
• Loss of Glycemic Control: Stress from fever, trauma, infection, or surgery may lead to a loss of glycemic control, necessitating temporary insulin therapy.

Contraindications

Precose is contraindicated in patients with:

• Known hypersensitivity to acarbose or any component of the formulation.
• Diabetic ketoacidosis.
• Cirrhosis of the liver.
• Inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction.
• Chronic intestinal diseases associated with marked disorders of digestion or absorption.
• Conditions that may deteriorate as a result of increased gas formation in the intestine.
• Severe renal impairment (creatinine clearance < 25 mL/min).

Possible side effect

The most common side effects are related to its mechanism of action in the digestive system and are dose-dependent. They are most prominent during the initial phase of therapy.

• Very Common (≥10%): Flatulence, diarrhea, abdominal pain.
• Common (1% to 10%): Nausea, dyspepsia.
• Uncommon (0.1% to 1%): Elevated serum transaminases (AST, ALT).
• Rare (<0.1%): Skin reactions (e.g., rash, erythema, urticaria), edema, ileus, jaundice, hepatitis.

Drug interaction

Precose has several important drug interactions to consider:

• Digestive Enzyme Preparations (e.g., amylase, pancreatin): Concomitant use may reduce the efficacy of Precose and is not recommended.
• Intestinal Adsorbents (e.g., charcoal) and Digestive Tract Dispersants: May reduce the effect of acarbose and should not be taken simultaneously.
• Cholestyramine: May reduce the bioavailability of acarbose.
• Other Hypoglycemic Agents (Sulfonylureas, Insulin, Metformin): Increases the hypoglycemic effect, raising the risk of hypoglycemia. Dose adjustments of the concomitant agent may be necessary.
• Neomycin: May enhance the hypoglycemic effect of acarbose and increase the frequency and severity of gastrointestinal side effects.

Missed dose

If a dose is missed, it should be skipped entirely. Do not double the next dose. Take the next tablet as prescribed with the first bite of the next scheduled meal. Taking acarbose between meals is ineffective and may increase the risk of gastrointestinal side effects without providing glycemic benefit.

Overdose

An overdose of Precose alone is not expected to cause hypoglycemia. It will, however, likely lead to severe gastrointestinal effects such as transient diarrhea, flatulence, and abdominal discomfort or pain. In the case of an overdose with a combination therapy that includes a sulfonylurea or insulin, hypoglycemia may occur. Treatment should be focused on the hypoglycemic agent. For acarbose-related gastrointestinal distress, supportive care is indicated.

Storage

• Store at room temperature between 20°C to 25°C (68°F to 77°F).
• Keep the tablets in their original container to protect them from moisture.
• Keep out of reach of children and pets.
• Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any new treatment. Never disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

• “As an endocrinologist, I find Precose to be a valuable tool for a specific patient subset—those with significant postprandial hyperglycemia on a high-carb diet. The GI side effects are a real barrier for some, but a slow, low-dose initiation is key to success.” – Dr. E. Vance, MD
• “It took about a month for the bloating and gas to settle down, but now my after-meal numbers are the most stable they’ve ever been. It works exactly as my doctor said it would.” – Patient, 58
• “From a clinical pharmacy perspective, patient education is paramount with this drug. They must understand why they have to take it with the first bite and why they need to use dextrose, not sucrose, if they are on combo therapy and have a low.” – Clinical Pharmacist
• “I couldn’t tolerate metformin, so we added Precose to my glipizide. My A1c dropped by a full point. The initial adjustment period was rough, but it was worth sticking with it.” – Patient, 64