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Central nervous system: Headache, vertigo, drowsiness Dermatologic: Urticaria, erythema Endocrine & metabolic: Hypoglycemia Gastrointestinal: Abdominal pain, diarrhea, flatulence Hepatic: Liver enzymes elevated Neuromuscular & skeletal: Weakness
Dosage Forms Excipient information presented when
available (limited, particularly for generics); consult specific product labeling. Tablet, oral: 25 mg, 50 mg, 100 mg Precose®: 25 mg, 50 mg, 100 mg
DeFronzo RA, "Pharmacologic Therapy for Type 2 Diabetes Mellitus," Ann Intern Med, 1999, 131(4):281-303. Ng DD, Ferry RJ Jr, Kelly A, et al, "Acarbose Treatment of Postprandial Hypoglycemia in Children After Nissen Fundoplication," J Pediatr, 2001, 139(6):877-9.
Drug Interactions Avoid Concomitant Use There are no known interactions where it is recommended to avoid concomitant use.
Acarbose may increase the levels/effects of: Hypoglycemic Agents The levels/effects of Acarbose may be increased by: Herbs (Hypoglycemic Properties); Neomycin; Pegvisomant
^ Accel-Amlodipine (Can) see AmLODIPine on page 103 ^ Accolate® see Zafirlukast on page 1573 ^ AccuNeb® see Albuterol on page 64 ^ Accutane® (Can) see ISOtretinoin on page 836 ^ ACE see Captopril on page 266 ^ Acephen™ [OTC] see Acetaminophen on page 40 ^ Acerola [OTC] see Ascorbic Acid on page 152 ^ Acetadote® see Acetylcysteine on page 49
Acarbose may decrease the levels/effects of: Digoxin The levels/effects of Acarbose may be decreased by: Corticosteroids (Orally Inhaled); Corticosteroids (Systemic); Luteinizing Hormone-Releasing Hormone Analogs; Somatropin; Thiazide Diuretics Mechanism of Action Competitive inhibitor of pancreatic α-glucosidases, resulting in delayed hydrolysis of ingested complex carbohydrates and disaccharides and absorption of glucose; dose-dependent reduction in postprandial serum insulin and glucose peaks; inhibits the metabolism of sucrose to glucose and fructose Pharmacodynamics Average decrease in fasting blood sugar: 20-30 mg/dL
(a seet a MIN oh fen)
Medication Safety Issues
Sound-alike/look-alike issues: Acephen® may be confused with AcipHex® FeverALL® may be confused with Fiberall® Triaminic™ Children's Fever Reducer Pain Reliever may be confused with Triaminic® cough and cold products Tylenol® may be confused with atenolol, timolol, Tuinal®, Tylenol® PM, Tylox® Other safety concerns: Duplicate therapy issues: This product contains acetaminophen, which may be a component of combination products. Do not exceed the maximum recommended daily dose of acetaminophen. International issues: Depon [Greece] may be confused with Depen brand name for penicillamine [U.S.]; Depin brand name for nifedipine [India]; Dipen brand name for dilitazem [Greece] Duorol [Spain] may be confused with Diuril brand name for chlorothiazide [U.S., Canada] and furosemide [Philippines] Paralen [Czech Republic] may be confused with Aralen brand name for chloroquine [U.S., Mexico, and Philippines]
Pharmacokinetics (Adult data unless noted)
Absorption: <2% absorbed as active drug Metabolism: Metabolized exclusively within the GI tract, principally by intestinal bacteria and by digestive enzymes; 13 metabolites have been identified Bioavailability: Low systemic bioavailability of parent compound Elimination: Fraction absorbed as intact drug is almost completely excreted in urine Dosing: Usual Oral: Adolescents and Adults: Dosage must be individualized on the basis of effectiveness and tolerance; do not exceed the maximum recommended dose (use slow titration to prevent or minimize GI effects): Initial: 25 mg 3 times/day; increase in 25 mg/day increments in 2-4 week intervals to maximum dose Maximum dose: Patients ≤60 kg: 50 mg 3 times/day Patients >60 kg: 100 mg 3 times/day Dosing adjustment in renal impairment: Administration Oral: Administer with first bite of each main meal Monitoring Parameters Fasting blood glucose; hemoglobin A1c; liver enzymes every 3 months for the first year of therapy and periodically thereafter Reference Range Target range: Blood glucose: Fasting and preprandial: 80-120 mg/dL; bedtime: 100-140 mg/dL Glycosylated hemoglobin (hemoglobin A1c): <7% Additional Information Acarbose has been used successfully to treat postprandial hypoglycemia in children with Nissen fundoplications. Six children (4-25 months) initially received 12.5 mg before each bolus feeding of formula containing complex carbohydrates. The dosage was increased in 12.5 mg increments (dosage range: 12.5-50 mg per dose) until postprandial serum glucose was stable ≥60 mg/dL. Most commonly reported side effects were flatulence, abdominal distension, and diarrhea (Ng, 2001). 40
Acetaminophen Serum Level Nomogram on page 1843
U.S. Brand Names Acephen™ [OTC]; APAP 500 [OTC];
Aspirin Free Anacin® Extra Strength [OTC]; Cetafen® Extra [OTC]; Cetafen® [OTC]; Excedrin® Tension Headache [OTC]; Feverall® [OTC]; Infantaire [OTC]; Little Fevers™ [OTC]; Mapap® Arthritis Pain [OTC]; Mapap® Children's [OTC]; Mapap® Extra Strength [OTC]; Mapap® Infant's [OTC]; Mapap® Junior Rapid Tabs [OTC]; Mapap® [OTC]; Nortemp Children's [OTC]; Ofirmev™; Pain & Fever Children's [OTC]; Pain Eze [OTC]; Silapap Children's [OTC]; Silapap Infant's [OTC]; Triaminic™ Children's Fever Reducer Pain Reliever [OTC]; Tylenol® 8 Hour [OTC]; Tylenol® Arthritis Pain Extended Relief [OTC]; Tylenol® Children's Meltaways [OTC]; Tylenol® Children's [OTC]; Tylenol® Extra Strength [OTC]; Tylenol® Infant's Concentrated [OTC]; Tylenol® Jr. Meltaways [OTC]; Tylenol® [OTC]; Valorin Extra [OTC]; Valorin [OTC] Canadian Brand Names Abenol®; Apo-Acetaminophen®; Atasol®; Novo-Gesic; Pediatrix; Tempra®; Tylenol® Therapeutic Category Analgesic, Non-narcotic; Antipyretic