From the Guidelines
Acarbose should not be used in patients with a GFR < 25 mL/min/1.73 m2 due to increased serum levels of the drug and its metabolites 1. When considering the use of Acarbose in patients with impaired renal function, it is essential to weigh the potential benefits against the risks.
Key Considerations
- Acarbose is only minimally absorbed, but with reduced kidney function, serum levels of the drug and its metabolites increase significantly 1.
- Although no adverse effects have been reported, the use of Acarbose in patients with significant kidney impairment is not recommended 1.
- If creatinine levels are only mildly elevated, the doctor might still prescribe Acarbose but will likely monitor kidney function regularly.
Alternative Options
- Certain DPP-4 inhibitors, such as linagliptin, can be used in CKD patients without the need for dose adjustments 1.
- GLP-1 receptor agonists, like liraglutide, may also be considered, but their use is recommended to be avoided when GFR is < 60 mL/min/1.73 m2 1.
Monitoring and Dosing
- The typical starting dose of Acarbose is 25 mg three times daily with meals, which may be gradually increased if needed and tolerated.
- Regular monitoring of kidney function is crucial when using Acarbose in patients with impaired renal function.
Conclusion is not allowed, so the answer just ends here.
From the FDA Drug Label
Plasma concentrations of acarbose in renally impaired volunteers were proportionally increased relative to the degree of renal dysfunction Long-term clinical trials in diabetic patients with significant renal dysfunction (serum creatinine > 2. 0 mg/dL) have not been conducted. Therefore, treatment of these patients with acarbose tablets is not recommended.
Acarbose is not recommended for patients with significant renal dysfunction (serum creatinine > 2.0 mg/dL) as there is a lack of long-term clinical trials in this population, and plasma concentrations of acarbose may be increased in renally impaired patients 2.
From the Research
Acarbose and Impaired Renal Function
There are no research papers to assist in answering this question regarding Acarbose.
Related Information on Renal Function and Medication
- The use of angiotensin-converting enzyme (ACE) inhibitors in patients with heart failure and renal insufficiency has been studied, and it was found that these patients are likely to show an early rise in serum creatinine levels after ACE inhibitor therapy 3.
- Metformin, a biguanide used in the management of type 2 diabetes mellitus, has been found to be safe for use in patients with renal dysfunction, with a recommended creatinine clearance of 30 mL/min/1.73 m2 4, 5.
- The estimation of creatinine clearance and glomerular filtration rate is important for drug dosing in patients with renal impairment, and recent recommendations suggest avoiding the use of the Cockcroft-Gault equation for drug dosing in these patients 6.
- Long-term NSAID therapy in patients with rheumatoid arthritis has been found to cause asymptomatic rises in serum creatinine levels, which are mostly reversible 7.
Key Points to Consider
- Renal function should be carefully monitored in patients with impaired renal function who are taking medications that may affect kidney function.
- The use of certain medications, such as ACE inhibitors and metformin, may require dose adjustments or close monitoring in patients with renal impairment.
- Regular monitoring of serum creatinine levels is essential in patients with renal insufficiency who are taking medications that may affect kidney function.