Precose

Precose (acarbose) is an oral alpha-glucosidase inhibitor medication designed for the management of type 2 diabetes mellitus. It functions by delaying the digestion of complex carbohydrates and disaccharides in the small intestine, thereby reducing postprandial blood glucose excursions. This mechanism offers a targeted approach to glycemic control, particularly after meals, and may be used as monotherapy or in combination with other antidiabetic agents. It is specifically indicated when diet, exercise, and other pharmacological interventions have not achieved adequate glycemic targets.

Features

• Active ingredient: Acarbose
• Drug class: Alpha-glucosidase inhibitor
• Available in 25 mg, 50 mg, and 100 mg oral tablets
• Delays carbohydrate digestion in the small intestine
• Reduces postprandial hyperglycemia without stimulating insulin secretion
• Not systemically absorbed; acts locally within the gastrointestinal tract

Benefits

• Effectively lowers postprandial blood glucose levels, reducing HbA1c by approximately 0.5–1.0%
• Minimizes risk of hypoglycemia when used as monotherapy due to its non-insulin-mediated mechanism
• May contribute to modest weight neutrality or slight weight loss, unlike some other antidiabetic agents
• Can be combined with metformin, sulfonylureas, or insulin for enhanced glycemic control
• Reduces glycemic variability, offering more stable daily glucose profiles
• Does not require dose adjustment in patients with renal impairment, as it is not renally excreted

Common use

Precose is primarily indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is most effective in individuals who experience significant postprandial hyperglycemia. It may be used as initial monotherapy or added to existing regimens including metformin, sulfonylureas, thiazolidinediones, or insulin. It is not indicated for type 1 diabetes or diabetic ketoacidosis.

Dosage and direction

The initial recommended dosage is 25 mg orally three times daily with the first bite of each main meal. Dosage should be titrated at 4–8 week intervals based on tolerability and glycemic response. Maintenance doses typically range from 50 mg to 100 mg three times daily. Maximum recommended dose is 100 mg three times daily for patients weighing >60 kg, and 50 mg three times daily for those ≤60 kg. Tablets should be swallowed whole with a small amount of liquid immediately before or with the first bite of the meal.

Precautions

Use with caution in patients with gastrointestinal disorders, such as inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction. May cause elevated serum transaminases; monitor liver function tests periodically during the first 6–12 months of therapy. Not recommended in patients with severe renal impairment (creatinine clearance <25 mL/min). May reduce hematocrit and serum iron levels; monitor complete blood count periodically. Use during pregnancy only if clearly needed; insulin is preferred for glycemic control in gestational diabetes.

Contraindications

Hypersensitivity to acarbose or any component of the formulation. Diabetic ketoacidosis. Cirrhosis. Inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction. Chronic intestinal diseases associated with marked disorders of digestion or absorption. Conditions that may deteriorate as a result of increased gas formation in the intestine.

Possible side effect

The most common adverse reactions are gastrointestinal, resulting from carbohydrate fermentation in the colon: flatulence (74%), diarrhea (31%), abdominal pain (19%). These effects often diminish with continued use. Less common reactions include elevated serum transaminases (rarely exceeding three times the upper limit of normal). Rare cases of ileus, pneumatosis cystoides intestinalis, and skin reactions including rash and urticaria have been reported. Hypoglycemia may occur when used in combination with other antidiabetic agents.

Drug interaction

May potentiate the hypoglycemic effect of sulfonylureas, insulin, or other antidiabetic agents. Digestive enzymes (e.g., amylase, pancreatin) and intestinal adsorbents (e.g., charcoal) may reduce efficacy and should not be taken concomitantly. Thiazide diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid may reduce hypoglycemic effect. Neomycin may increase hypoglycemic effect and intensify gastrointestinal side effects.

Missed dose

If a dose is missed, it should be omitted if it is almost time for the next scheduled dose. Do not double the dose. Take the next dose with the next meal as prescribed. Taking acarbose after a meal is ineffective as the medication must be present during carbohydrate ingestion.

Overdose

Acarbose alone does not cause hypoglycemia. However, in combination with other hypoglycemic agents, overdose may result in hypoglycemia. Treatment should include oral glucose (dextrose); sucrose (cane sugar) is ineffective due to inhibited disaccharide hydrolysis. Severe cases may require intravenous glucose infusion. There is no specific antidote; supportive measures and monitoring of blood glucose are essential.

Storage

Store at controlled room temperature 20°–25°C (68°–77°F). Keep container tightly closed. Protect from moisture. Do not use if tablets show signs of discoloration or deterioration. Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and individualized treatment recommendations. Do not initiate, discontinue, or modify any medication regimen without medical supervision.

Reviews

Clinical studies demonstrate that acarbose reduces HbA1c by 0.5–1.0% and postprandial glucose by approximately 40–50 mg/dL. Gastrointestinal side effects are common initially but often subside with continued use. Many endocrinologists note its particular utility in patients with predominant postprandial hyperglycemia and those seeking weight-neutral options. Long-term studies suggest potential benefits in reducing cardiovascular risk in impaired glucose tolerance populations.