Precose: Control Post-Meal Blood Sugar with Alpha-Glucosidase Inhibition
| Product dosage: 50mg | |||
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Synonyms | |||
Precose (acarbose) is an alpha-glucosidase inhibitor oral medication specifically designed to manage type 2 diabetes by targeting postprandial hyperglycemia. It works locally within the small intestine to delay the digestion of complex carbohydrates and disaccharides, resulting in a slower and more controlled rise in blood glucose levels after meals. This mechanism offers a complementary approach to diabetes management, particularly for patients who experience significant glucose spikes following carbohydrate intake. It is often used in combination with other antidiabetic agents or diet and exercise when glycemic control is not achieved by lifestyle modifications alone.
Features
- Contains acarbose as the active pharmaceutical ingredient
- Available in oral tablet formulations (25 mg, 50 mg, 100 mg)
- Functions as an alpha-glucosidase inhibitor
- Acts locally within the brush border of the small intestine
- Delays carbohydrate digestion and glucose absorption
- Does not stimulate insulin secretion
- Requires administration with the first bite of each main meal
Benefits
- Effectively reduces postprandial blood glucose excursions
- Lowers glycosylated hemoglobin (HbA1c) levels
- Minimizes risk of hypoglycemia when used as monotherapy
- May contribute to modest weight stabilization or loss
- Compatible with other antidiabetic regimens including metformin, sulfonylureas, or insulin
- Provides a mechanism of action distinct from other antidiabetic classes
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 beneficial for patients who exhibit pronounced postprandial hyperglycemia despite dietary modifications. Clinical evidence supports its use both as monotherapy and in combination with other antidiabetic agents when additional glycemic control is required. The medication may be especially appropriate for patients who are intolerant to other antidiabetic drugs or who seek to avoid medications that cause hypoglycemia or weight gain.
Dosage and direction
The initial dosage is typically 25 mg administered orally three times daily with the first bite of each main meal. Dosage may be titrated gradually at 4-8 week intervals based on tolerability and therapeutic response. Maintenance doses typically range from 50 mg to 100 mg three times daily. For patients with body weight less than 60 kg, the maximum recommended dose is 50 mg three times daily; for those above 60 kg, the maximum is 100 mg three times daily. Tablets should be swallowed whole with a small amount of liquid, not chewed or crushed, and must be taken with meals to achieve optimal therapeutic effect.
Precautions
Patients should be advised that Precose does not substitute for appropriate dietary management. Gastrointestinal symptoms are common initially but typically diminish with continued treatment. Hepatic transaminases should be monitored periodically during therapy, particularly at higher doses. Use with caution in patients with renal impairment (serum creatinine >2.0 mg/dL) as acarbose is excreted renally. Not recommended for patients with significant renal dysfunction or those undergoing dialysis. May affect digoxin bioavailability; monitor digoxin levels accordingly. Patients should be educated about the management of potential gastrointestinal effects and the distinction between this medication’s side effects and hypoglycemic symptoms.
Contraindications
Precose is contraindicated in patients with known hypersensitivity to acarbose or any component of the formulation. It should not be used in patients with diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, colonic ulceration, or partial intestinal obstruction. Contraindicated in patients with chronic intestinal diseases associated with marked disorders of digestion or absorption, or in conditions that may deteriorate as a result of increased gas formation in the intestine. Not indicated for use in type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis.
Possible side effect
The most common adverse reactions are gastrointestinal: flatulence (74%), diarrhea (31%), and abdominal pain (19%). These effects are dose-dependent and typically diminish in frequency and intensity with continued treatment. Other reported effects include elevated serum transaminases (rarely requiring discontinuation), and skin reactions including rash and erythema. Hypoglycemia may occur when used in combination with other antidiabetic agents. In rare instances, ileus, pneumatosis cystoides intestinalis, and hepatitis have been reported. Patients should report persistent gastrointestinal symptoms or any signs of hepatic dysfunction.
Drug interaction
Precose may reduce the bioavailability of digoxin; monitor levels and adjust dosage accordingly. Thiazide diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid may reduce the hypoglycemic effect of acarbose. Charcoal, digestive enzyme preparations (amylase, pancreatin) and intestinal adsorbents may reduce the effectiveness of acarbose and should not be taken concomitantly. When used with sulfonylureas or insulin, may increase the risk of hypoglycemia; such combinations require careful monitoring and possible adjustment of concomitant medication doses.
Missed dose
If a dose is missed, it should be omitted and the regular dosing schedule resumed with the next meal. Do not double the dose to make up for a missed administration. Taking acarbose without carbohydrates or between meals significantly increases the risk of gastrointestinal adverse effects without providing therapeutic benefit. Patients should be educated about the importance of consistent dosing with meals rather than attempting to compensate for missed doses.
Overdose
An overdose of Precose alone is not expected to cause hypoglycemia. However, when taken in excessive quantities, the primary manifestation would be transient gastrointestinal effects including diarrhea, flatulence, and abdominal discomfort. Treatment should be symptomatic and supportive. In cases of combination therapy with other hypoglycemic agents, blood glucose should be monitored and appropriate management for hypoglycemia instituted if necessary. Since acarbose is not significantly absorbed systemically, dialysis is not expected to enhance elimination.
Storage
Store at controlled room temperature 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep container tightly closed and protect from moisture. Keep out of reach of children. Do not use beyond the expiration date printed on the packaging. Tablets should be kept in their original container with the desiccant canister provided to maintain stability. Do not transfer to other containers that may not provide adequate protection from humidity.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Precose is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Individual patient responses may vary, and treatment decisions should be based on professional medical judgment considering the patient’s complete medical history, current medications, and specific health circumstances. Patients should not alter their dosage or discontinue medication without consulting their healthcare provider.
Reviews
Clinical studies demonstrate that Precose effectively reduces postprandial glucose elevations by 40-50 mg/dL and lowers HbA1c by 0.5-1.0% in most patients. Gastroenterological adverse effects are frequently reported in initial treatment phases but typically subside with continued use. The medication is particularly valued for its unique mechanism of action and low risk of hypoglycemia when used as monotherapy. Many clinicians find it beneficial as adjunctive therapy in patients who continue to experience postprandial hyperglycemia despite treatment with other antidiabetic agents. Long-term studies suggest potential benefits in reducing cardiovascular risk factors associated with postprandial hyperglycemia.