Precose (acarbose) is an oral alpha-glucosidase inhibitor specifically designed to manage type 2 diabetes by targeting postprandial hyperglycemia. Unlike sulfonylureas or biguanides, it acts locally within the gastrointestinal tract to delay the digestion of complex carbohydrates, resulting in a moderated and flattened glucose absorption curve. This mechanism offers a complementary approach to diabetes management, particularly for patients struggling with significant glucose excursions after meals. It is typically prescribed as an adjunct to diet and exercise, or in combination with other antidiabetic agents when glycemic targets are not met with monotherapy.

Features

• Contains acarbose as the active pharmaceutical ingredient (API)
• Available in 25 mg, 50 mg, and 100 mg oral tablets
• Functions as an alpha-glucosidase enzyme inhibitor
• Works within the brush border of the small intestine
• Not systemically absorbed; exerts local action in the GI tract
• Requires consistent carbohydrate intake for efficacy and tolerability

Benefits

• Significantly reduces postprandial blood glucose peaks, lowering HbA1c by 0.5–1.0%
• Minimizes risk of hypoglycemia when used as monotherapy
• May contribute to modest weight neutrality or mild weight loss
• Does not stimulate insulin secretion, reducing pancreatic stress
• May improve overall glycemic variability throughout the day
• Compatible with other antidiabetic medications for combination therapy

Common use

Precose is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. It is particularly effective in populations with high carbohydrate intake and in individuals exhibiting pronounced postprandial hyperglycemia. It may be used as monotherapy or in combination with other oral antidiabetic agents such as metformin, sulfonylureas, or insulin when additional glycemic control is required.

Dosage and direction

The initial dosage is 25 mg administered orally three times daily at the start (with the first bite) of each main meal. The dosage may be increased gradually 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 chewed with the first bite of food or swallowed whole with a few sips of liquid.

Precautions

• Gastrointestinal adverse effects (flatulence, diarrhea, abdominal pain) are common initially; these usually diminish with continued use
• Not recommended in patients with significant renal impairment (creatinine clearance <25 mL/min)
• Should be used cautiously in patients with inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction
• May elevate serum transaminase levels; monitor liver function tests periodically
• Not intended for use in type 1 diabetes or diabetic ketoacidosis

Contraindications

• Hypersensitivity to acarbose or any component of the formulation
• Diabetic ketoacidosis
• Cirrhosis of the liver
• 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 frequently reported adverse reactions are gastrointestinal and result from the mechanism of action:

• Flatulence (74%)
• Diarrhea (31%)
• Abdominal pain (19%)
• Less common: elevated serum transaminases (rarely exceeding three times the upper limit of normal)
• Rare cases of ileus, pneumatosis cystoides intestinalis, and skin reactions (rash, urticaria) have been reported

Drug interaction

• May reduce the bioavailability of digoxin; monitor digoxin levels
• Charcoal-containing preparations and digestive enzyme preparations (amylase, pancreatin) may reduce efficacy
• Concomitant use with cholestyramine may decrease absorption
• May enhance the hypoglycemic effect of sulfonylureas or insulin; dose adjustment may be necessary
• Antacids may decrease efficacy

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 at the usual time with the first bite of the meal.

Overdose

An overdose may result in transient diarrhea, flatulence, and abdominal discomfort. Unlike other antidiabetic agents, acarbose overdose does not cause hypoglycemia. However, when used in combination with insulin or sulfonylureas, hypoglycemia may occur. Treatment is symptomatic and supportive; glucose (dextrose) should be administered orally or intravenously if hypoglycemia occurs, as sucrose hydrolysis will be impaired.

Storage

Store at controlled room temperature (20°–25°C or 68°–77°F); excursions permitted between 15°–30°C (59°–86°F). Keep in original container, tightly closed, and protect from moisture. Keep out of reach of children. Do not use after the expiration date printed on the packaging.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting, changing, or stopping any medication. Individual patient responses may vary. Proper diagnosis and treatment should be based on a healthcare provider’s evaluation of the patient’s specific clinical circumstances.

Reviews

Clinical studies and post-marketing surveillance indicate that Precose is effective in reducing postprandial glucose and HbA1c levels, particularly in patients with high carbohydrate diets. Gastrointestinal side effects are frequently reported but often decrease over time. Many clinicians find it valuable as an adjunct therapy, especially when postprandial glucose control is a priority. Patient adherence can be challenging initially due to GI effects, but those who persist often achieve meaningful glycemic improvements.