Precose (acarbose) is an alpha-glucosidase inhibitor oral medication designed specifically for the management of type 2 diabetes. It functions by delaying the digestion of complex carbohydrates and table sugar in the intestine, thereby reducing the sharp rise in blood glucose that occurs after meals (postprandial hyperglycemia). This mechanism offers a targeted approach to glycemic control, often used in combination with other antidiabetic agents or diet and exercise alone. It is particularly beneficial for individuals who experience significant glucose excursions following carbohydrate intake.

Features

• Active Pharmaceutical Ingredient: Acarbose
• Drug Class: Alpha-glucosidase inhibitor
• Administration: Oral tablet
• Available Strengths: 25 mg, 50 mg, and 100 mg
• Delays the digestion of ingested carbohydrates (sucrose, starch)
• Acts locally within the lumen of the small intestine
• Minimal systemic absorption

Benefits

• Effectively lowers postprandial blood glucose and HbA1c levels.
• Reduces the risk of potentially dangerous hypoglycemic episodes when used as monotherapy.
• May contribute to modest weight stabilization or loss, unlike some other antidiabetic agents.
• Provides a complementary mechanism of action for use in combination therapy.
• Targets the specific problem of meal-related glucose spikes.
• Does not stimulate insulin secretion, working on digestive enzymes instead.

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 controlling high blood sugar after meals. It can be used as monotherapy or in combination with other oral antidiabetic agents (such as sulfonylureas, metformin, or thiazolidinediones) or with insulin when glycemic control on these agents alone is not adequate. Its use is predicated on the patient consuming a diet rich in complex carbohydrates.

Dosage and direction

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

• Initial Dose: 25 mg administered orally three times daily at the start (with the first bite) of each main meal.
• Maintenance Dose: After 4 to 8 weeks, the dose may be increased to 50 mg three times daily. Further increments may be made at subsequent 3-month intervals based on 1-hour postprandial glucose levels and tolerance.
• Maximum Dose: 100 mg three times daily for patients weighing > 60 kg (132 lbs). For patients weighing ≤ 60 kg, the maximum recommended dose is 50 mg three times daily.
• Administration: It is critical that the tablet be taken with the first bite of the main meal to ensure the drug is present in the intestine when carbohydrates arrive. 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 like flatulence, diarrhea, and abdominal pain, especially at the initiation of therapy. These usually diminish over time with continued treatment.
• Hypoglycemia: When used as monotherapy, Precose does not cause hypoglycemia. However, when used in combination with a sulfonylurea or insulin, hypoglycemia may occur. It is important to note that oral glucose (dextrose, D-glucose) must be used to treat such an event, as Precose will inhibit the digestion of table sugar (sucrose), making it ineffective for rapid hypoglycemia correction.
• Hepatic Impairment: Plasma concentrations of acarbose may be significantly elevated in patients with impaired liver function. Use with caution and avoid in patients with significant hepatic disease.
• Renal Impairment: Plasma concentrations of acarbose are significantly elevated in patients with severe renal impairment (creatinine clearance < 25 mL/min). Its use is not recommended in these patients.
• Elevated Serum Transaminases: Transient and asymptomatic elevations of serum transaminases have been reported. Levels greater than 3 times the upper limit of normal should be monitored and may require discontinuation.

Contraindications

Precose is contraindicated in patients with:

• Known hypersensitivity to acarbose or any of the formulation’s constituents.
• 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.

Possible side effect

The most common side effects are related to its mechanism of action in the gastrointestinal tract and are dose-dependent.

• Very Common (>10%): Flatulence, diarrhea, abdominal pain.
• Common (1-10%): Nausea, dyspepsia.
• Uncommon (0.1-1%): Elevated liver enzymes (AST/ALT).
• Rare (<0.1%): Skin reactions such as rash or urticaria, edema, ileus, jaundice, hepatitis.
• Isolated cases of hypersensitive skin reactions have been reported.

Drug interaction

• 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 Disabling Agents: May reduce the effects of Precose and should not be taken simultaneously.
• Cholestyramine: May reduce the bioavailability of acarbose.
• Other Hypoglycemic Agents: The blood glucose-lowering effect of Precose may be additive when combined with sulfonylureas, insulin, or metformin, increasing the risk of hypoglycemia.
• Neomycin: Can enhance the blood glucose-lowering effect of acarbose and increase the frequency and severity of gastrointestinal side effects.

Missed dose

If a dose is missed, it should be skipped. Do not take a double dose to make up for the missed one. Take the next dose at the usual time with the next meal. Taking acarbose after a meal has started is not effective.

Overdose

An overdose of Precose alone is not expected to result in hypoglycemia. It may lead to transient increases in flatulence, diarrhea, and abdominal discomfort. Due to the minimal systemic absorption of acarbose, systemic adverse effects are unlikely. Treatment should be symptomatic and supportive.

Storage

• Store Precose tablets at room temperature, between 20°C to 25°C (68°F to 77°F).
• Keep the medication in its original container, tightly closed, and protected 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. The information provided is based on the drug’s prescribing information but may not be exhaustive.

Reviews

• “As an endocrinologist, I find Precose to be a valuable tool for patients with pronounced postprandial hyperglycemia. Its unique mechanism fills a specific niche. The GI side effects are a real hurdle for some patients, but a slow, careful titration can greatly improve tolerance. It’s not a first-line agent for everyone, but for the right patient, it’s exceptionally effective at what it does.” – Dr. A. Reynolds, MD
• “Starting Precose was rough with the gas and bloating, but my doctor had me start with a quarter dose and work up slowly. After a few weeks, it got much better. My after-meal numbers are now consistently in range for the first time in years, and I haven’t had a single low blood sugar episode. It’s been a game-changer for my daily management.” – Patient T.S.
• “From a clinical pharmacology perspective, acarbose is a fascinating drug. Its site-specific action and lack of systemic effects make it a very clean agent from a drug-interaction standpoint, outside of the gut. Its primary limitation is patient adherence due to the initial adverse effects, which requires thorough patient education and setting realistic expectations.” – Clinical Pharmacist Review
• “I use it in combination with metformin. It definitely helps smooth out the spikes I used to see after breakfast and lunch. You have to be strict about taking it with the first bite, or it doesn’t work nearly as well. It’s a specific tool, but it does its job well.” – Patient M.K.