Acarbose is a medication prescribed to help manage type 2 diabetes, a condition leading to elevated blood sugar levels. It works by targeting alpha-glucosidase enzymes in the small intestine. These enzymes break down complex carbohydrates into simpler sugars. Acarbose slows this digestion process, reducing the sudden rise in blood sugar after meals. By delaying glucose absorption, acarbose helps maintain stable blood sugar levels throughout the day.
Acarbose Dosing Guidelines
Healthcare providers typically initiate acarbose treatment with a low dose to allow the body to adjust and minimize gastrointestinal side effects. The usual starting dosage is 25 milligrams (mg) taken orally three times daily, with the first bite of each main meal. Some individuals might start with an even lower frequency, such as 25 mg once daily, to further reduce initial digestive discomfort before gradually increasing to three times a day.
The dosage is then gradually increased based on patient tolerance and blood sugar control. This titration usually occurs at intervals of 4 to 8 weeks. Doses can increase from 25 mg three times daily to 50 mg three times daily, and for some patients, to 100 mg three times daily. The maximum recommended daily dose depends on body weight: 50 mg three times daily for individuals weighing less than 60 kilograms, and 100 mg three times daily for those 60 kg or more.
Individual Dosage Considerations
The optimal acarbose dose is individualized and determined by various factors. A healthcare provider considers a patient’s kidney function; its use is generally not recommended in cases of significant renal dysfunction due to potential accumulation. Liver function is also evaluated, with regular monitoring of serum transaminase levels recommended, especially during the first year of treatment, as elevations can occur, particularly with doses exceeding 50 mg three times daily.
Other medications are important considerations, as acarbose can interact with certain drugs. Digestive enzyme preparations might decrease acarbose’s effectiveness, and combining acarbose with other diabetes medications like sulfonylureas or insulin can increase the risk of low blood sugar (hypoglycemia). The patient’s response to the drug, including efficacy and side effects, plays a significant role in dosage adjustments. Medical supervision is essential for adjusting acarbose doses to achieve optimal blood sugar control while minimizing adverse effects.
Risks of High Acarbose Doses
Exceeding the recommended maximum dose of acarbose significantly increases the likelihood and severity of certain side effects. The most common adverse effects are gastrointestinal in nature, including flatulence (gas), diarrhea, and abdominal pain. These symptoms occur because acarbose slows carbohydrate digestion, leading to more undigested carbohydrates reaching the colon, where they are fermented by bacteria, producing gas. Higher doses can amplify these digestive issues, making them more bothersome.
While rare, there is a possibility of elevated liver enzymes (serum transaminases) with acarbose therapy, particularly at doses greater than 50 mg three times daily. These elevations are usually asymptomatic and reversible upon dose reduction or discontinuation. In very rare instances, more severe liver injury, including cases of hepatitis, has been reported. An overdose of acarbose can exacerbate these gastrointestinal symptoms and, while it does not typically cause low blood sugar on its own, medical attention should be sought if an overdose is suspected.