What is the recommended dosage and usage of Acarbose (alpha-glucosidase inhibitor) for patients with type 2 diabetes mellitus?

From the Guidelines

Acarbose therapy for type 2 diabetes should start at a low dose and gradually increase to 300 mg/day, as it has been shown to have a similar hypoglycaemic effect to metformin 1500 mg/day in newly diagnosed patients with diabetes 1. The recommended dosage and usage of Acarbose (alpha-glucosidase inhibitor) for patients with type 2 diabetes mellitus is as follows:

• Starting dose: 25 mg once daily with the first bite of each main meal
• Gradually increasing to 50-100 mg three times daily as tolerated
• Maximum recommended daily dose: 300 mg Key points to consider when prescribing Acarbose include:
• It should always be taken with meals to inhibit intestinal alpha-glucosidase enzymes
• Dose titration should occur slowly over weeks or months to minimize gastrointestinal side effects like flatulence, bloating, and diarrhea
• Patients should be aware that hypoglycemia is unlikely when acarbose is used as monotherapy, but can occur when combined with insulin or insulin secretagogues
• Blood glucose monitoring is essential when starting or adjusting acarbose therapy, with HbA1c levels checked every 3-6 months to assess long-term glycemic control Acarbose is particularly useful for patients with predominantly postprandial hyperglycemia and can be used as monotherapy or in combination with other antidiabetic medications, such as biguanides, sulfonylureas, TZDs, or insulin 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION There is no fixed dosage regimen for the management of diabetes mellitus with acarbose tablets or any other pharmacologic agent. Dosage of acarbose tablets must be individualized on the basis of both effectiveness and tolerance while not exceeding the maximum recommended dose of 100 mg t.i. d. Acarbose tablets should be taken three times daily at the start (with the first bite) of each main meal. The recommended starting dosage of acarbose tablets is 25 mg given orally three times daily at the start (with the first bite) of each main meal. Maintenance Dosage Once a 25 mg t.i. d. dosage regimen is reached, dosage of acarbose tablets should be adjusted at 4-8 week intervals based on one-hour postprandial glucose or glycosylated hemoglobin levels, and on tolerance. The dosage can be increased from 25 mg t.i.d. to 50 mg t.i.d. Some patients may benefit from further increasing the dosage to 100 mg t.i.d. The maintenance dose ranges from 50 mg t.i.d. to 100 mg t.i. d.

The recommended dosage and usage of Acarbose for patients with type 2 diabetes mellitus is as follows:

• Initial Dosage: 25 mg three times daily at the start of each main meal
• Maintenance Dosage: 50 mg to 100 mg three times daily, adjusted at 4-8 week intervals based on glucose or glycosylated hemoglobin levels, and on tolerance
• Maximum Dosage: 50 mg three times daily for patients ≤ 60 kg, and 100 mg three times daily for patients > 60 kg 2

From the Research

Dosage and Usage of Acarbose

• The recommended dosage of Acarbose for patients with type 2 diabetes mellitus is up to 100 mg three times daily 3, 4.
• The initial dosage is typically 25 mg three times daily, which can be increased depending on patient response 4.
• Acarbose can be used as monotherapy with diet and exercise, or in combination with other antidiabetes agents such as sulfonylureas 5, 4.
• The addition of Acarbose to insulin therapy has also been shown to be safe and effective in reducing HbA1c and postprandial glucose levels 6.

Efficacy and Safety

• Acarbose has been shown to be effective in reducing postprandial hyperglycemia and improving glycemic control in patients with type 2 diabetes mellitus 5, 3, 4.
• The use of Acarbose has also been associated with a reduced risk of cardiovascular events in high-risk individuals with glucose intolerance 5.
• Common adverse events associated with Acarbose include gastrointestinal symptoms such as abdominal pain, flatulence, and diarrhea, which are typically more frequent at the start of treatment and attenuate over time 3, 4, 7.

Patient Considerations

• Acarbose is not a cure for diabetes, and patients should continue to follow a healthy diet and exercise regimen in addition to taking the medication 4.
• Patients with type 2 diabetes mellitus who are inadequately controlled with insulin and diet therapy may benefit from the addition of Acarbose to their treatment regimen 6.
• The safety and tolerability of Acarbose have been demonstrated in patients with type 1 and type 2 diabetes mellitus over a 1-year treatment period 7.