Acarbose, known under the brand name Precose, is an oral alpha-glucosidase inhibitor primarily prescribed to manage blood sugar levels in individuals with type 2 diabetes. Beyond its primary use, research suggests that acarbose may also play a role in weight management. This article explores the uses, mechanisms, side effects, and considerations associated with acarbose, with a particular focus on its potential for weight loss.
What is Acarbose and How Does It Work?
Acarbose is commonly used to help lower blood sugar levels in people with type 2 diabetes. Acarbose works in the small intestine to block the breakdown of complex carbohydrates into glucose (sugar), the sugar that your body can absorb. It slows the absorption of sugar from your small intestines. Carbohydrates that are eaten are digested by enzymes in the intestine into smaller sugars, which are absorbed into the body and increase blood sugar levels. The process of carbohydrate digestion requires the pancreas to release into the intestine alpha-amylase enzymes, which digest the large carbohydrates into smaller carbohydrates called oligosaccharides. The cells lining the small intestine then release alpha-glucosidase enzymes that further digest the oligosaccharides into smaller sugars, like glucose, that can be absorbed. Precose is a man-made oligosaccharide designed to slow down the actions of alpha-amylase and alpha-glucosidase enzymes, thereby slowing the appearance of sugar in the blood after a meal.
Acarbose is available in the following dosage forms that are taken by mouth: 25 mg oral tablets, 50 mg oral tablets, and 100 mg oral tablets. Acarbose oral tablets should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.
Acarbose for Type 2 Diabetes
Acarbose is primarily prescribed as an anti-diabetic drug in DM II. Clinical Uses: Acarbose is used 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.
Diabetes Mellitus (Type 1 and Type 2) Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Type 2 diabetes is a chronic condition that may be reversible with diet and lifestyle changes. Symptoms include excessive thirst, frequent urination, weight loss, fatigue, and an unusual odor to your urine. Most people don't know they have type 2 diabetes until they have a routine blood test.
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A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets. The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Type 1 diabetes is treated with insulin, exercise, and a diabetic diet. Type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used.
Acarbose is an anti-hyperglycemic agent in DM II and lower the weight of many diabetic patients reportedly. There is controversy about the effect of acarbose on weight loss in different societies with different diet. In this study, the effect of this drug was investigated on the Iranians patients as a society with the high carbohydrate utilization in the meals. As shown in the results, the patients treated with acarbose have a higher rate of weight loss after 2 months.
The Potential Role of Acarbose in Weight Loss
Acarbose has been known as an overweight medication in some studies with mechanisms including appetite reduction and fat or calorie malnutrition especially in long time use. Acarbose helps you lose weight by blocking carbs from being digested. Most weight loss medications work on the brain to help you lose weight. In contrast, Acarbose works on the intestines to help you lose weight. Acarbose is a medication originally developed for the management of type 2 diabetes, but has been found to be effective for weight loss as well. Studies show that the prevalence of obesity has being elevated in Iran in the recent years due to increasing urbanization. In controlling weight gain, diet is an important factor.
A double blind randomized controlled clinical trial was performed on 66 patients with the body mass index (BMI) between 25 and 35 kg/m2. Patients were divided in treatment and control groups using the randomization. The treatment group took 100 mg acarbose 3 times a day for 20 weeks in combination with the low calorie diet and exercise. Control group was given placebo, low calorie diet, and exercise. BMI was measured after 20 weeks. Patients in acarbose and placebo group had a non significant difference in BMI at baseline. Reducing in weight was considered in every month in both groups, but this reduction was higher in the treatment group. At the 5th month, the difference of BMI in the treatment group was significantly lower than the placebo group (2.31 ± 0.6 vs.
The subjects consisted of 10 men (25%) and 30 women (75%) with a mean age of 31 ± 8.8 years. As could be seen in Figure 2 the BMI reduced in both groups during the study, but this reduction was higher in the acarbose group (P < 0.001). The differences in each interval are shown in Table 2. This study showed that acarbose can reduce weight in over weight and obese non-diabetic people; this effect is continuous and progressive. Considering the high prevalence of overweight and obesity in society and the importance of this as one of the major risk factors for chronic diseases such as severe cardiovascular diseases, diabetes and cancer, the requirement for therapy is obvious.
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Variety of treatments for obesity and overweight has been suggested. One of these drugs is α glycosidase inhibitors including acarbose. Several clinical trials have shown similar results to the present study. The results of a study by Hauner et al. to investigate the effect of acarbose on stability after low calorie diet induced weight loss confirmed the finding of our study. In that double-blind controlled clinical trial, patients with a BMI between 32 and 38 kg/m2 were treated with the low calorie diet for 10-16 weeks and then 26 weeks with acarbose.
Acarbose, especially in combination with the individualized diet and exercise, works well for obese and overweight patients that have a high carbohydrate intake. Many patients have told us this medication makes them want to stay away from carbs. However, we have found Acarbose even more effective when combined with a low-carb diet. Acarbose can raise your awareness of hidden carbs which have crept into your diet.
Important Considerations Before Using Acarbose
Do not take acarbose unless it has been prescribed to you by a healthcare provider. Take it as prescribed. Do not share acarbose with other people, even if they have the same condition as you. It may harm them. Keep acarbose out of the reach of children. Take acarbose with the first bite of each meal (up to three times per day). Acarbose has the biggest impact on your blood sugar levels after you eat or drink, not on your fasting (before you have had anything to eat or drink) blood sugar levels.
Certain conditions that cause increased stress on your body, like fever, trauma (such as a car accident), infection, or surgery can change the amount of diabetes medicines you need to take to control your diabetes. Talk to your healthcare provider if you have any of these conditions to decide if your medicine needs to be changed. Talk to your healthcare provider about how to prevent, recognize, and manage low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), and diabetes-related problems. Traditional treatments for low blood sugar do not work if you are taking acarbose. Instead you will need to use things like dextrose, honey, or milk to treat low blood sugar levels.
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if acarbose is right for you. In particular, make sure that you discuss any of the following: Other Medicines and Supplements. Acarbose may interact with other medicines and supplements. Before using acarbose, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. Pregnancy. It is not known if or how acarbose could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Breastfeeding. It is not known if acarbose passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop acarbose.
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Contraindications and Precautions
Who should not use acarbose?
- Allergies to Ingredients: People who are allergic to any of the following should not take acarbose: Precose, Acarbose, Any of the ingredients in the specific product dispensed. Your pharmacist can tell you all of the ingredients in the specific acarbose products they stock.
- Diabetic Ketoacidosis (DKA): People with DKA should not take acarbose.
- Cirrhosis: People with cirrhosis should not take acarbose.
- Inflammatory Bowel Disease (IBD): People with IBD should not take acarbose.
- Colonic Ulceration: People with ulcers in the lining of the large intestine should take acarbose.
- Intestinal Obstruction: People with a partial blockage, blockage, or may be prone to a blockage in the small or large intestine should not use acarbose.
- Chronic Intestinal Problems: People with long-term intestinal problems interfering with digestion or absorption or with intestinal problems that could get worse with increased gas should not use acarbose.
- Kidney Problems: Acarbose should not be used if your kidneys are not working as well as they should be. If there is a concern about the health of your kidneys, your healthcare provider may do tests to determine if they are working well enough to take this medicine.
Potential Side Effects
Common side effects of Precose includeabdominal pain,diarrhea,gas (flatulence), andincreased liver enzymes. What are the most common side effects of acarbose? The most common side effects of acarbose are listed below. Tell your healthcare provider if you have any of these side effects that bother you: Stomach pain, Diarrhea, and Gas. There may be other side effects of acarbose that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine.
The increased gastrointestinal tract symptoms in patients treated with Precose are a manifestation of the mechanism of action of Precose and are related to the presence of undigested carbohydrate in the lower GI tract. If the prescribed diet is not observed, the intestinal side effects may be intensified.
Less common, but more serious side effects include:
- Severe Allergic Reactions: Acarbose may cause allergic reactions, which can be serious.
- Low Blood Sugar (Hypoglycemia): Acarbose can cause low blood sugar when used with other medicines for diabetes.
- Pneumatosis Cystoides Intestinalis: Pneumatosis cystoides intestinalis (air trapped in the walls of the small or large intestine) is rare, but can happen in people who take acarbose.
Patients should be aware of these potential side effects and consult their healthcare provider if they experience any concerning symptoms.
Interactions with Other Medications and Substances
Acarbose may interact with other medicines and supplements. Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. In particular, make sure that you discuss if you are using any of the following before taking acarbose: Other medicines for diabetes, especially insulin or other medicines that increase your insulin levels, such as sulfonylureas. Pancreatic enzymes that contain amylase or pancreatin, which are medicines used to help with digestion. Some examples include Creon, Zenpep, or Viokace. Many other medicines can increase your blood sugar and can interfere with the effect of acarbose.
There are no known interactions between acarbose and food or drinks. It is unknown if drinking alcohol will affect acarbose, but alcohol may affect blood sugar levels in people with diabetes. This may interfere with the effect of acarbose. It is best to limit the amount of alcohol you drink.
Dosage and Administration
Take this medication by mouth as directed by your doctor, usually 3 times daily with the first bite of a meal. The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Take this medication with a meal.
Lifestyle Considerations
Your doctor will want to check your progress at regular visits , especially during the first few weeks you take this medicine. It is very important to follow carefully any instructions from your health care team about: Alcohol-Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team. Other medicines-Do not take other medicines during the time you are taking acarbose unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems. Counseling-Other family members need to learn how to prevent side effects or help with side effects if they occur.
Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy. Travel-Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times. In case of emergency-There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
Managing Hypoglycemia
Acarbose does not cause hypoglycemia (low blood sugar). However, low blood sugar can occur if you take acarbose with another type of diabetes medicine, delay or miss a meal or snack, exercise more than usual, drink alcohol, or cannot eat because of nausea or vomiting. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people may feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly.
Symptoms of low blood sugar include anxiety; behavior change similar to being drunk; blurred vision; cold sweats; confusion; cool, pale skin; difficulty in thinking; drowsiness; excessive hunger; fast heartbeat; headache (continuing); nausea; nervousness; nightmares; restless sleep; shakiness; slurred speech; or unusual tiredness or weakness. If symptoms of low blood sugar occur, eat glucose tablets or gel or honey, or drink fruit juice to relieve the symptoms. Table sugar (sucrose) or regular (nondiet) soft drinks will not work. Also, check your blood for low blood sugar. Glucagon is used in emergency situations when severe symptoms such as seizures (convulsions) or unconsciousness occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it.
Acarbose: A Cost-Effective Option
Acarbose is the generic version of Precose. It has been on the market over 20 years, so the price of the medication is cost effective. Most patients pay between $25-$35 for a month supply.