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Acarbose (Precose) discription and use:niddk:"In late 1995 the U.S. Food and Drug Administration (FDA) approved the use of acarbose for managing Type 2 diabetes. The brand name for acarbose is Precose. Acarbose blocks the enzymes that digest starches from food. This causes a slower and lower rise of blood sugar through the day. Acarbose is especially effective right after meals. People with diabetes must take acarbose with the first bite of food at each meal. Acarbose may be used alone as the only diabetes medicine, or with the group of blood-sugar-lowering medicines called sulfonylureas, such as the brand names Diabeta, Glucotrol, and Micronase." http://www.niddk.nih.gov/health/diabetes/summary/acarbose/acarbose.htm Acarbose (Precose) Pro's and Con's plus additional information:Diabetes Monitor:"Pro's: Brings down the blood sugar and glycohemoglobin levels. No hypoglycemia if this drug is used as the only diabetic medication. Most people will find it easier to lose weight. It can be used alone, as the first drug therapy for diabetes (if meal planning and exercise fail to control the blood sugar level), or in combination with any other diabetes pills, including sulfonylureas (such as Glucotrol, Glynase, glyburide, et al), metformin (Glucophage), and/or with insulin by injection. It may also help control blood sugar (when used together with insulin) in insulin-dependent (Type I) diabetes" http://www.diabetesmonitor.com/acarbose.htm Acarbose (precose) side effects:AAFP:"Gastrointestinal effects, including flatulence, diarrhea and cramps, occur in 21 to 97 percent of patients Elevated liver function values (reversible with discontinuation of acarbose therapy) Serum transaminase level should be checked every three months during the first year of treatment Acarbose has not been studied in patients with plasma creatinine levels higher than 2.0 mg per dL (180 µmol per L)" http://www.aafp.org/afp/971101ap/purnell.html Precose (Acarbose) indications and usage:Bayer:"In initiating treatment for type 2 diabetes mellitus, diet should be emphasized as the primary form of treatment. Caloric restriction and weight loss are essential in the obese diabetic patient. Proper dietary management alone may be effective in controlling blood glucose and symptoms of hyperglycemia. The importance of regular physical activity when appropriate should also be stressed. If this treatment program fails to result in adequate glycemic control, the use of PRECOSE® should be considered. The use of PRECOSE® must be viewed by both the physician and patient as a treatment in addition to diet, and not as a substitute for diet or as a convenient mechanism for avoiding dietary restraint." http://www.bayerpharma-na.com/products/co03precose.asp How does Precose (Acarbose) work?:Joslin diabetes center:"Precose slows the digestion of carbohydrate (sugars and starches) in the small intestine. Precose decreases peaks in blood glucose levels that occur after eating by delaying absorption of carbohydrates (sugar and starches) into the bloodstream. When used alone, Precose does not cause low blood glucose (hypoglycemia). If used in combination with some diabetes medications hypoglycemia may occur. Guidelines for use:You should take the prescribed dose with the FIRST BITE of each main meal. A small dose will be started and your health care provider will gradually increase it as needed. Your health care provider may want you to combine Precose with another type of diabetes pill. Since Precose works differently than the other diabetes pills, it will not interfere with their action. Combined with these pills, Precose may further improve your control." http://www.joslin.harvard.edu/education/library/precose.shtml Precose / Glyset (Alpha-glucosidase inhibitors) a comparison:Diabetes net:"Like metformin, Precose had been used in Europe for several years before its approval in the U.S. Its action is quite different from sulfonylureas and metformin. By slowing the digestion of carbohydrates in the small intestine, the blood sugar rise after a meal is lessened. Acarbose works by inhibiting enzymes in the intestine that break carbohydrates down, so glucose levels rise more slowly and the person's own internal production of insulin can more easily respond.The way in which these drugs work is also the major source of their side effects. Although these drugs are very safe, their side effects can be annoying. If digestion is greatly inhibited, this may cause abdominal bloating, gas and diarrhea. The alpha glucosidase inhibitors should always be started on a minimal dose, often half of the smallest tablet, and then gradually increased over time. This greatly minimizes gastric side effects; side effects also tend to decrease over time." http://www.diabetesnet.com/diabetes_treatments/precose_glyset.php Acarbose (Precose) contraindications:valuepharmaceuticals:"Acarbose is contraindicated in patients with known hypersensitivity to the drug and in patients with diabetic ketoacidosis, or cirrhosis. Acarbose is also contraindicated in patients with inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, or in patients predisposed to intestinal obstruction. In addition, acarbose is contraindicated in patients who have chronic intestinal diseases associated with marked disorders of digestion or absorption and in patients who have conditions that may deteriorate as a result of increased gas formation in the intestine." http://shop.valuepharmaceuticals.com/public/med_info/precose.htm Diabetes Study Highlights Benefit Of Precose In Controlling Blood Glucose:docguide:"Adding the a-glucosidase inhibitor, Bayer Corp.'s Precose(R) (acarbose tablets), to existing therapies for patients with type II diabetes improves long-term blood glucose control, according to final results of the United Kingdom Prospective Diabetes Study.The HbA1c (a measure of long term blood glucose levels) in the Precose-treated patients fell from a mean of 7.9 to 7.4 percent -- a significant improvement in blood glucose control that may help reduce the risk of complications such as eye disease and kidney damage.In the Precose arm of the UKPDS, 1,946 patients were allocated at random to Precose therapy or placebo, titrating to a maximum dose of 100 mg three times daily. The results showed that Precose lowered HbA1c by a highly statistically significant mean of 0.5 percent compared with placebo (in actual therapy analysis).Professor Rury Holman, co-director of the UKPDS, said that patients experienced a very similar reduction in HbA1c over the three-year study period regardless of which existing therapy Precose was added to -- insulin, sulphonylurea, metformin or diet alone." http://www.docguide.com/dg.nsf/PrintPrint/95EA8F5B769AA2A8852566980049CC8E Acarbose (Precose) clinical results:centerwatch:"To evaluate the long-term efficacy of precose in improving glycemic control in subjects with NIDDM, a one-year, multicenter, randomized, double-blind, placebo-controlled study was conducted. The study involved 354 subjects with NIDDM. Clinical studies demonstrated a strong association between hyperglycemia and an increased risk of microvascular tissue damage. Trials involving Precose established that hemoglobin levels are a more significant predictor of the onset or progression of retinopathy in NIDDM diabetic patients than blood glucose concentration. Precose significantly reduced hemoglobin levels in NIDDM subjects maintained on dietary therapy alone. The magnitude of the treatment effect steadily increased during active treatment; diabetic retinopathy was reduced by approximately 30%. In addition, reduction in postprandial glucose concentrations were observed in subjects receiving Precose" http://www.centerwatch.com/patient/drugs/DRU35.html Acarbose (Precose) warnings and precautions:rxlist:"Hypoglycemia: Because of its mechanism of action, PRECOSE ® when administered alone should not cause hypoglycemia in the fasted or postprandial state. Sulfonylurea agents or insulin may cause hypoglycemia. Because PRECOSE ® given in combination with a sulfonylurea or insulin will cause a further lowering of blood glucose, it may increase the potential for hypoglycemia. Hypoglycemia does not occur in patients receiving metformin alone under usual circumstances of use, and no increased incidence of hypoglycemia was observed in patients when PRECOSE ® was added to metformin therapy. Oral glucose (dextrose), whose absorption is not inhibited by PRECOSE ®, should be used instead of sucrose (cane sugar) in the treatment of mild to moderate hypoglycemia. Sucrose, whose hydrolysis to glucose and fructose is inhibited by PRECOSE ®, is unsuitable for the rapid correction of hypoglycemia. Severe hypoglycemia may require the use of either intravenous glucose infusion or glucagon injection." http://rxlist.com/cgi/generic/acarbose_wcp.htm Search Nursing Diabetics http://www.nursingdiabetics.com/A-Z_list/ ******************************************************
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