Drug Summary - Alpha-glucosidase Inhibitors (Acarbose)

(Refer to: Drug review - Alpha-glucosidase Inhibitors (Acarbose) for drug review and references)

(See Strength of Recommendations Taxonomy (SORT) for explanation of Grade A-C)

Mechanism of Action	Prevents the conversion of complex carbohydrates into monosaccharides within the intestine thereby decreasing the ability to absorb monosaccharides
Glycaemic efficacy and indications	HbA1C reduction when used as monotherapy of between 0.6 and 0.8%		A
Microvascular Outcomes	Reduction of Microvascular Complications are inferred from the benefit of improved glycaemic control.		B
Macrovascular and Mortality Outcomes	Acarbose significantly reduced the risk of cardiovascular events by 49% in patients with impaired glucose tolerance. No data for patients with Diabetes		B
Hypoglycaemia	Hypoglycaemia rates are no different to placebo except when combined with Insulin or Insulin Secretagogues		B
Non glycaemic benefits	Weight neutral		B
Side Effects and Precautions	Transient elevation of hepatic transaminases Gastrointestinal Side Effects (Flatulence and diarrhoea)		B B
Dosing	eGFR	Acarbose
	≥30 ml/min	Start with 50 mg once daily with meals, and increase by 50 mg every two weeks if tolerated. Maximum dose is 100 mg x3 daily.
	<30 ml/min	Not recommended
Cost	High (R407.00)