Download acarbose - Elsevier

1
Name:
Dimensions:
A
ROLODEX.WMF
3096 x 2311 pixels
acarboseL❙ L(ah-car-bose) Prandase , Precose
CLASSIFICATION
Clinical: Antidiabetic
Pharmacotherapeutic: Alpha-glucosidase inhibitor
PREGNANCY/LACTATION
Category B: Insulin, rather than oral agent, is drug of choice during pregnancy. Unknown if drug crosses placenta or is distributed in breast milk.
AVAILABILITY (Rx)
Tablets: 25 mg, 50 mg, 100 mg
PHARMACOKINETICS
Oral
ONSET
PEAK
DURATION
—
1 hr
12–24 hrs
Absorption not necessary for therapeutic effect. Metabolized by intestinal
digestive enzymes/microorganisms. Elimination occurs through renal and
fecal route. Half-life: 2.7–9 hrs (increased in impaired renal function).
ACTION/THERAPEUTIC EFFECT
Delays glucose absorption and digestion of carbohydrates, resulting in smaller
rise in blood glucose concentration after meals, lowering postprandial hyperglycemia. Does not enhance insulin secretion.
USES
Use either alone or in combination with a sulfonylurea, insulin, or metformin
to lower blood glucose in pts with type 2 diabetes mellitus when diet plus
either acarbose or a sulfonylurea do not give adequate glucose control.
ADMINISTRATION/HANDLING
Oral
• Give with the first bite of each main meal.
• Store at room temperature, avoid moisture.
INDICATION/ROUTE/DOSAGE
Diabetes mellitus
Oral: Adults, elderly: Initially, 25 mg (1⁄ 2 a 50 mg tablet) 3 times/day at the start
(with first bite) of each main meal. Range: 50–100 mg 3 times/day. Maximum: <60 kg: 50 mg 3 times/day; >60 kg: 100 mg 3 times/day.
PRECAUTIONS
Contraindications: Significant renal dysfunction (serum creatinine
>2mg/dl), hypersensitivity to drug, diabetic ketoacidosis or cirrhosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction or predisposition to intestinal obstruction, chronic intestinal diseases associated
with marked disorders of digestion or absorption, conditions that may deteriorate as result of increased gas formation in the intestine. Cautions: Malnourished, or debilitated, those with renal or hepatic dysfunction, cardiac disease.
Increased risk for hypoglycemia when given in combination with insulin.
INTERACTIONS
DRUG: Digestive enzymes, intestinal absorbents (e.g., charcoal) reduce acarbose effect. Do not use concurrently. Sulfonylureas may produce hypoglycemia. Diuretics, corticosteroids, phenytoin, sympathomimetics,
phenothiazines, nicotinic acid, thyroid hormones, estrogens, oral contraceptives, calcium channel blockers, isoniazid may produce hyperglycemia.
FOOD: None significant. LAB VALUES: May increase serum transaminase
levels and slightly reduce Hct.
SIDE EFFECTS
FREQUENT: Transient GI disturbances: flatulence (77%), diarrhea (33%),
abdominal pain (21%). Symptoms tend to diminish in frequency and intensity
over time.
ADVERSE REACTIONS/TOXIC EFFECTS
None significant.
© 2001 W. B. Saunders Company
NURSING IMPLICATIONS
Baseline Assessment: Question for hypersensitivity to acarbose. Check
blood glucose level. Discuss lifestyle to determine extent of learning, emotional needs. Assure follow-up instruction if pt/family do not thoroughly understand diabetes management or glucose-testing technique.
Intervention/Evaluation: Monitor blood glucose and food intake. Monitor liver
function, glycosylated Hgb. Assess for hypoglycemia (cool, wet skin, tremors,
dizziness, anxiety, headache, tachycardia, numbness in mouth, hunger, diplopia) or hyperglycemia (polyuria, polyphagia, polydipsia, nausea, vomiting, dim
vision, fatigue, deep rapid breathing). Check for adverse skin reactions, jaundice.
Monitor hematology reports. Assess for bleeding or bruising. Be alert to conditions that alter glucose requirements: fever, increased activity or stress, surgical
procedure.
Patient/Family Teaching: Carry oral glucose (dextrose) instead of cane sugar
(sucrose) for immediate response to hypoglycemic episode. Prescribed diet is
principal part of treatment; do not skip or delay meals. Diabetes mellitus requires
lifelong control. Check blood glucose/urine as ordered. Serum transaminase levels should be checked q3mos during first year of treatment and periodically thereafter. Wear medical alert identification. Check with physician when glucose
demands are altered (e.g., fever, infection, trauma, stress, heavy physical activity).
Avoid alcoholic beverages. Do not take other medication without consulting
physician. Weight control, exercise, hygiene (including foot care), and nonsmoking are essential parts of therapy. Protect skin, limit sun exposure. Avoid exposure
to infections. Select clothing, positions that do not restrict blood flow. Inform dentist, physician, or surgeon of this medication before any treatment.
Lifespan Considerations: Safety and efficacy in children not established. No
special considerations for the elderly.