From the Guidelines
Acarbose should not be used in patients with a GFR < 25 mL/min/1.73 m2, and its use in patients with GFR 27 is not recommended due to limited clinical experience and potential accumulation of the drug and its metabolites in severe renal impairment. When considering the use of Acarbose in patients with impaired renal function, it is essential to weigh the benefits and risks, as there is limited clinical experience in this population 1. The standard starting dose of Acarbose is 25 mg three times daily with meals, which may be gradually increased to 50-100 mg three times daily if needed and tolerated. However, in renal impairment, it's advisable to start at the lowest dose and titrate more slowly while monitoring for side effects. Some key points to consider when using Acarbose in patients with impaired renal function include:
- Acarbose works by inhibiting intestinal alpha-glucosidases, delaying carbohydrate digestion and absorption, which helps control postprandial glucose levels.
- Acarbose is minimally absorbed into the systemic circulation (less than 2%), its primary action occurs in the gastrointestinal tract, making it theoretically safer than some other antidiabetic medications in renal impairment.
- Common side effects include flatulence, diarrhea, and abdominal discomfort, which may be more problematic in patients with renal dysfunction.
- Regular monitoring of renal function is essential during treatment, as the small amount of Acarbose that is absorbed may accumulate in severe renal impairment 1. Given the potential risks and limited clinical experience, alternative treatments may be considered for patients with GFR 27.
From the FDA Drug Label
Patients with severe renal impairment (Clcr < 25 mL/min/1. 73m2) attained about 5 times higher peak plasma concentrations of acarbose and 6 times larger AUCs than volunteers with normal renal function.
Acarbose is not recommended for patients with severe renal impairment (GFR < 25 mL/min/1.73m2) due to significantly increased peak plasma concentrations and AUCs. Since the patient's GFR is 27, which is close to the threshold of 25 mL/min/1.73m2, caution should be exercised when using Acarbose in this patient. The FDA drug label does not provide a clear recommendation for patients with a GFR of 27, but it suggests that patients with severe renal impairment may require dose adjustment or close monitoring. However, given the patient's GFR is slightly above the threshold, Acarbose may be used with close monitoring of the patient's condition and renal function. 2
From the Research
Acarbose Use in Patients with Impaired Renal Function
- Acarbose is an alpha-glucosidase inhibitor used to manage non-insulin-dependent diabetes mellitus (NIDDM) by delaying carbohydrate absorption in the gut 3.
- The safety of acarbose in patients with impaired renal function, specifically those with a glomerular filtration rate (GFR) of 27, is a concern due to potential contraindications in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) 4.
Renal Implications and Acarbose
- A study published in 2018 found that acarbose users with severe renal insufficiency did not exhibit an increased incidence of liver injury compared to non-users, suggesting that acarbose may be safe for patients with impaired renal function 4.
- Another study from 2016 compared the renal outcomes of pioglitazone and acarbose in diabetic patients and found that both treatments provided similar glycemic control and changes in estimated GFR (eGFR) and urinary albumin-to-creatinine ratio (UACR) 5.
Considerations for Acarbose Use
- Acarbose is generally considered safe, with gastrointestinal complaints being the most common side effects, which often disappear after 1-2 months of treatment 6, 7.
- The drug is minimally absorbed from the gut, and no systemic adverse effects have been demonstrated after long-term administration 7.
- However, it is essential to note that acarbose is not recommended for patients with certain conditions, such as inflammatory bowel disease, or those who have undergone intestinal resection 3.
GFR 27 and Acarbose
- While there is limited direct evidence on the use of acarbose in patients with a GFR of 27, the available studies suggest that acarbose may be safe for patients with impaired renal function, including those with severe renal insufficiency 4, 5.
- However, it is crucial to carefully evaluate the benefits and risks of acarbose treatment in patients with significant renal impairment and to monitor their renal function and overall health closely 4, 5.