Drug reference

Acarbose

α-Glucosidase inhibitor (antidiabetic) · Antidiabetic

START

25 mg PO 3 times daily with first bite of meal; titrate slowly

TYPICAL MAX

300 mg/day (>60 kg); 150 mg/day (≤60 kg)

STOP IF

Severe hepatitis or pneumatosis intestinalis

WATCH

GI tolerance (titrate slowly to limit flatulence); LFTs; use glucose (not sucrose) for hypos

CDSCO approvedSchedule HATC A10BF01

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · with meal
PEAK: 1h · postprandial
t½: 2h · minimal systemic
DURATION: 4h · meal effect

EXCRETION

Mostly faecal; ~35% renal if absorbed

route + CYP

INTERACTIONS

6 major

SEVERE in our sources

PREGNANCY

Generally not recommended (insulin preferred in pregnancy).

FDA category + note

Top interactionssee all 6 →

GatifloxacinSevereDatabaseDDInter
LeflunomideSevereDatabaseDDInter
LomitapideSevereDatabaseDDInter
MipomersenSevereDatabaseDDInter

Mechanism

Reversibly inhibits intestinal brush-border α-glucosidases (sucrase, maltase, glucoamylase), delaying carbohydrate digestion and absorption; flattens postprandial glucose rise without intrinsic hypoglycaemia risk.

Indications

Type 2 diabetes mellitus (adjunct to diet)Postprandial hyperglycaemia in type 1 (off-label adjunct)

Dosing

Adult: 25 mg PO 3 times daily with the first bite of each main meal; titrate every 4–8 weeks; usual 50–100 mg three times daily; max 300 mg/day (>60 kg) or 150 mg/day (≤60 kg).
Pediatric: Not established.
Renal adjustment: CrCl 25–60: caution; CrCl <25: contraindicated.
Hepatic adjustment: Severe hepatic impairment: contraindicated.
Geriatric: No specific adjustment.
Max dose: 300 mg/day (>60 kg)

Pharmacokinetics

Onset

Glucose-lowering with each meal

Peak effect

~1 h (local gut effect)

Duration

Meal-related

Half-life

~2 h (minimal systemic exposure)

Bioavailability

<2% systemic (essentially gut-acting)

Protein binding

Not applicable

Metabolism

Bacterial / digestive enzyme degradation in gut

Excretion

Renal (~35% as metabolites if absorbed); mostly faecal

Contraindications

Inflammatory bowel disease / chronic intestinal disease
Severe hepatic impairment
Severe renal impairment (CrCl <25)
Hypersensitivity
Diabetic ketoacidosis

Side effects

Common

Flatulence (very common)Abdominal painDiarrhoeaBloating

Serious

Pneumatosis cystoides intestinalis (rare)
Severe hepatotoxicity (rare, high dose)
Severe hypersensitivity

Pregnancy & lactation

Pregnancy

Generally not recommended (insulin preferred in pregnancy).

Lactation

Limited data; minimal systemic absorption.

Drug interactions

Gatifloxacin

Severe

Database

Drug interaction classified as: antagonism

Source: DDInter

Leflunomide

Severe

Database