Acarbose Medications

Acarbose is an alpha-glucosidase inhibitor medication used to control type 2 diabetes by inhibiting the digestion of carbohydrates in the small intestine, thereby reducing post-meal blood glucose levels.

Precose

Acarbose

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25 | 50mg

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Information About Acarbose

Acarbose belongs to the class of α-glucosidase inhibitors and is prescribed primarily for type 2 diabetes mellitus. By competitively inhibiting intestinal brush-border enzymes that break down complex carbohydrates, it slows glucose absorption and blunts post-prandial blood-sugar spikes. The drug received FDA approval in 1995 under the brand name Precose and later gained EMA endorsement as Glucobay. In Singapore, the Health Sciences Authority (HSA) classifies acarbose as a prescription-only medicine for adjunctive therapy in adults with type 2 diabetes when diet, exercise, and other agents do not achieve target glycaemic control. Beyond its approved indication, clinicians sometimes employ acarbose off-label for pre-diabetes management and for reducing post-prandial hyperglycaemia in gestational diabetes, though evidence remains limited. Generic formulations are widely available worldwide, offering a cost-effective alternative to branded products. Common brand names include Precose, Glucobay, and Acarbose-M, while generic tablets range from 25 mg to 100 mg. Understanding its precise mechanism, pharmacokinetics, and safety profile helps patients and healthcare providers use acarbose effectively.

What is Acarbose?

Acarbose is an oral antidiabetic agent classified as an α-glucosidase inhibitor. The drug targets the enzymes sucrase, maltase, and isomaltase located on the intestinal lumen, preventing the cleavage of disaccharides into absorbable monosaccharides. The United States Food and Drug Administration (FDA) first approved acarbose in 1995 for adult type 2 diabetes, and the European Medicines Agency (EMA) followed with approval of the same formulation in 1996, subsequently expanding the label to include combination therapy with metformin (EMA, 202). In Singapore, the HSA incorporated acarbose into the national formulary in 1998, permitting its use alongside metformin, sulfonylureas, or insulin as part of a comprehensive glycaemic strategy.

At the molecular level, acarbose binds competitively to the active site of α-glucosidases, reducing the rate at which complex carbohydrates are hydrolysed. The result is a delayed and diminished rise in post-prandial plasma glucose, which in turn decreases overall glycaemic variability. Brand-specific products such as Precose (U.S.) and Glucobay (EU) contain the same active moiety, but differ in excipients and tablet strengths. Generic versions are marketed by numerous manufacturers worldwide, ensuring broader access, especially in cost-sensitive markets.

How Acarbose Works

Mechanism of Action

Acarbose acts as a reversible, competitive inhibitor of intestinal α-glucosidases. By occupying the catalytic pocket of enzymes like sucrase and maltase, it prevents the hydrolysis of dietary starches and disaccharides into glucose and fructose. This inhibition is non-systemic; the drug remains largely confined to the gastrointestinal lumen, with less than 2 % absorbed into the bloodstream (FDA labeling). Consequently, the primary pharmacodynamic effect is a reduction in the rate of glucose entry into the portal circulation after meals.

Therapeutic Effects

The delayed carbohydrate absorption translates clinically into lower post-prandial glucose excursions. In a 24-week, double-blind trial involving 703 patients with type 2 diabetes, acarbose added to metformin reduced the mean 2-hour post-prandial glucose by 28 % compared with metformin alone (Diabetes Care, 2018). By flattening these peaks, acarbose contributes to improved HbA1c levels, reduced insulin demand, and potentially lower risk of cardiovascular events linked to glycaemic variability.

Onset and Duration

Acarbose begins to act within 30 minutes after oral ingestion, aligning with the timing of carbohydrate digestion. Peak inhibition of α-glucosidase activity occurs roughly 1-2 hours post-dose, matching the typical post-prandial glucose rise. The drug’s effects persist for the duration of carbohydrate exposure in the gut, usually 4-6 hours, after which normal enzyme activity resumes. Steady-state pharmacodynamic effects are achieved after 2-3 days of consistent dosing.

Approved Uses and Applications

FDA/EMA-Approved Indications

Adjunctive therapy for type 2 diabetes in adults, used when lifestyle measures and first-line agents (e.g., metformin) fail to achieve target HbA1c.
Combination regimens with metformin, sulfonylureas, or insulin to further improve post-prandial control.
Geriatric use is permitted with dose adjustments, acknowledging slower gastric emptying in older adults.

Off-Label Uses

Pre-diabetes: Small pilot studies suggest acarbose may delay progression to overt diabetes by attenuating post-prandial spikes, though larger trials are needed (J Endocrinol, 2021).
Gestational diabetes: Limited case series report modest glycaemic benefits, but safety data in pregnancy remain inconclusive, prompting caution.

Clinical Efficacy

Across pivotal Phase III trials, acarbose consistently lowered HbA1c by .5-.8 % when added to standard therapy. In the US pivotal trial, 35 % of participants achieved an HbA1c < 7 % versus 22 % in the placebo arm (FDA, 1995). Meta-analyses of 12 randomized studies confirm a statistically significant reduction in 2-hour post-prandial glucose (mean difference ≈ 1.2 mmol/L) (Cochrane Review, 2019).

Buying Acarbose from Our Online Pharmacy

Why Choose Our Service

Through our platform, patients in Singapore gain discreet access to acarbose when local pharmacies run low on stock or when insurance coverage restricts specific brands. Our pharmacy service adheres to international regulatory standards, ensuring each tablet matches the potency and quality of FDA-approved products.

Brand Names and Generic Options

Precose (50 mg, 100 mg tablets) - the original U.S. brand.
Glucobay (25 mg, 50 mg) - widely marketed in Europe and Asia.
Acarbose-M - a regional brand often available in Singapore’s private hospitals.
Generic acarbose - produced by certified manufacturers in India, China, and Europe, offering comparable efficacy at a lower price point.

Quality & Safety

Our online pharmacy partners with licensed international distributors that comply with WHO GMP guidelines, guaranteeing that each batch undergoes rigorous testing for potency, purity, and microbial limits.

Pricing & Access

Customers typically see a 30 %-45 % reduction when selecting generic tablets versus brand-name equivalents. In addition, we offer a Lifetime 10 % discount on all reorders, making long-term therapy more affordable.

Discreet Delivery

Express shipping arrives within ~7 days; standard delivery takes ~3 weeks. All parcels are packaged in unmarked, tamper-evident containers to protect privacy.

Dosing, Formulations & Administration

Available Formulations

Acarbose is supplied as immediate-release tablets in four strengths: 25 mg, 50 mg, 75 mg, and 100 mg. The drug is not formulated as an extended-release product, nor is it available as a liquid or injectable preparation.

Typical Dosing Ranges

For adult type 2 diabetes, initiation usually starts at 25 mg once daily with the first main meal. The dose is titrated by 25 mg increments weekly, based on tolerability, up to a maximum of 100 mg three times daily (with each main meal). Clinical guidelines recommend the lowest effective dose to minimise gastrointestinal side effects.

Administration Guidelines

Take with the first bite of a carbohydrate-containing meal. Acarbose should be swallowed whole; crushing or chewing may alter its local effect.
Avoid high-fat meals while initiating therapy, as fat slows gastric emptying and can exacerbate flatulence.
Concurrent medications: Maintain at least a 30-minute gap between acarbose and antidiabetic agents that require rapid absorption, such as rapid-acting insulin, to prevent unpredictable glucose excursions.

Note: Exact dosing must be individualized by a qualified healthcare professional, taking into account renal function, age, and concomitant therapies.

Safety Profile & Considerations

Common Side Effects

Flatulence (≈ 45 % of patients)
Diarrhoea (≈ 30 %)
Abdominal discomfort (≈ 20 %)
Nausea (≈ 10 %)

These gastrointestinal events arise from unabsorbed carbohydrates fermented by colonic bacteria and usually diminish after 2-4 weeks of continued therapy.

Serious Adverse Events

Hypoglycaemia: Rare when acarbose is used alone, but risk increases when combined with sulfonylureas or insulin. Severe episodes occurred in < 2 % of trial participants (FDA, 1995).
Hepatic dysfunction: Isolated cases of elevated transaminases have been reported; routine liver function monitoring is advised during the first 3 months.

Contraindications

Pregnancy and lactation: Not recommended due to insufficient safety data.
Severe renal impairment (eGFR < 30 mL/min/1.73 m²): Contraindicated because drug accumulation may increase gastrointestinal toxicity.
Inflammatory bowel disease (e.g., Crohn’s, ulcerative colitis): Avoided due to heightened risk of abdominal pain and diarrhoea.

Drug Interactions

CYP450 enzymes: Acarbose undergoes negligible hepatic metabolism, so direct CYP interactions are minimal.
Other antidiabetics: Concomitant sulfonylureas, meglitinides, or insulin may amplify hypoglycaemic risk; dose reductions of the secretagogues may be required.
Digestive enzymes: Pancreatic enzyme supplements can reduce acarbose’s local activity; spacing doses by at least 30 minutes is prudent.

Special Populations

Elderly: Start at the lowest dose (25 mg) and titrate slowly, monitoring for dehydration secondary to diarrhoea.
Hepatic impairment: No dosage adjustment required, but monitor liver enzymes.
Renal impairment: Avoid use in severe renal failure; mild to moderate dysfunction may necessitate dose reduction (25 mg BID).

Frequently Asked Questions

How does acarbose differ from other α-glucosidase inhibitors such as miglitol? Acarbose has a larger molecular size and lower systemic absorption, resulting in a higher incidence of gastrointestinal side effects but minimal risk of systemic drug interactions, whereas miglitol is more readily absorbed and may cause fewer GI complaints.
What is the typical time frame for noticing a reduction in post-prandial glucose after starting acarbose? Patients often report measurable decreases in 2-hour post-meal glucose within the first week, with full HbA1c improvement becoming evident after 8-12 weeks of consistent use.
Which side effect should prompt me to seek medical attention while taking acarbose? Persistent diarrhoea exceeding three loose stools per day, signs of dehydration, or any occurrence of severe hypoglycaemia (e.g., dizziness, confusion, loss of consciousness) warrants prompt evaluation.
Can I take acarbose if I have a high-fat diet? While acarbose remains effective, high-fat meals may delay its onset of action and increase the likelihood of abdominal discomfort; a balanced diet with moderate carbohydrate content is advisable.
Is it safe to combine acarbose with metformin? Yes, the combination is approved and frequently used; both agents address different aspects of glucose control-acarbose reduces post-prandial spikes, while metformin lowers hepatic glucose production.
What should I do if I experience flatulence from acarbose? Gradually titrating the dose, avoiding excessive intake of complex carbohydrates during the initial weeks, and considering over-the-counter simethicone can help alleviate gas.
Does acarbose affect blood pressure or lipid levels? Primary studies have not shown significant changes in blood pressure or lipid profiles; its action is confined to carbohydrate digestion rather than systemic metabolic pathways.
Can acarbose be used in patients with mild renal impairment? Mild to moderate renal impairment may require dose reduction, but the drug is not contraindicated; regular monitoring of renal function is recommended.
What information should I provide my doctor when discussing acarbose? • Current list of medications, including over-the-counter supplements. • History of gastrointestinal disorders (e.g., IBS, IBD). • Recent renal and liver function test results. • Specific glycaemic targets and any recent HbA1c values.

Disclaimer

The information provided about acarbose is for general knowledge only. It does not replace professional medical consultation or the official prescribing information for medications containing this ingredient. All treatment decisions, including dosing, formulation selection, and monitoring, should be made under the supervision of a qualified healthcare provider who can assess individual medical history, current medications, and specific health needs. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to medications containing acarbose for individuals who may have limited availability through traditional pharmacies, prescription-based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication containing acarbose.