ACARBOSE

Adverse Reactions
Central nervous system: Headache, vertigo, drowsiness Dermatologic: Urticaria, erythema Endocrine & metabolic: Hypoglycemia Gastrointestinal: Abdominal pain, diarrhea, flatulence Hepatic: Liver enzymes elevated Neuromuscular & skeletal: Weakness

Dosage Forms Excipient information presented when

available (limited, particularly for generics); consult specific product labeling. Tablet, oral: 25 mg, 50 mg, 100 mg Precose: 25 mg, 50 mg, 100 mg

References
DeFronzo RA, "Pharmacologic Therapy for Type 2 Diabetes Mellitus," Ann Intern Med, 1999, 131(4):281-303. Ng DD, Ferry RJ Jr, Kelly A, et al, "Acarbose Treatment of Postprandial Hypoglycemia in Children After Nissen Fundoplication," J Pediatr, 2001, 139(6):877-9.

Drug Interactions Avoid Concomitant Use There are no known interactions where it is recommended to avoid concomitant use.

Increased Effect/Toxicity
Acarbose may increase the levels/effects of: Hypoglycemic Agents The levels/effects of Acarbose may be increased by: Herbs (Hypoglycemic Properties); Neomycin; Pegvisomant

^ Accel-Amlodipine (Can) see AmLODIPine on page 103 ^ Accolate see Zafirlukast on page 1573 ^ AccuNeb see Albuterol on page 64 ^ Accutane (Can) see ISOtretinoin on page 836 ^ ACE see Captopril on page 266 ^ Acephen [OTC] see Acetaminophen on page 40 ^ Acerola [OTC] see Ascorbic Acid on page 152 ^ Acetadote see Acetylcysteine on page 49

Decreased Effect
Acarbose may decrease the levels/effects of: Digoxin The levels/effects of Acarbose may be decreased by: Corticosteroids (Orally Inhaled); Corticosteroids (Systemic); Luteinizing Hormone-Releasing Hormone Analogs; Somatropin; Thiazide Diuretics Mechanism of Action Competitive inhibitor of pancreatic -glucosidases, resulting in delayed hydrolysis of ingested complex carbohydrates and disaccharides and absorption of glucose; dose-dependent reduction in postprandial serum insulin and glucose peaks; inhibits the metabolism of sucrose to glucose and fructose Pharmacodynamics Average decrease in fasting blood sugar: 20-30 mg/dL

Acetaminophen

(a seet a MIN oh fen)

Medication Safety Issues

Sound-alike/look-alike issues: Acephen may be confused with AcipHex FeverALL may be confused with Fiberall Triaminic Children's Fever Reducer Pain Reliever may be confused with Triaminic cough and cold products Tylenol may be confused with atenolol, timolol, Tuinal, Tylenol PM, Tylox Other safety concerns: Duplicate therapy issues: This product contains acetaminophen, which may be a component of combination products. Do not exceed the maximum recommended daily dose of acetaminophen. International issues: Depon [Greece] may be confused with Depen brand name for penicillamine [U.S.]; Depin brand name for nifedipine [India]; Dipen brand name for dilitazem [Greece] Duorol [Spain] may be confused with Diuril brand name for chlorothiazide [U.S., Canada] and furosemide [Philippines] Paralen [Czech Republic] may be confused with Aralen brand name for chloroquine [U.S., Mexico, and Philippines]

Pharmacokinetics (Adult data unless noted)

Absorption: <2% absorbed as active drug Metabolism: Metabolized exclusively within the GI tract, principally by intestinal bacteria and by digestive enzymes; 13 metabolites have been identified Bioavailability: Low systemic bioavailability of parent compound Elimination: Fraction absorbed as intact drug is almost completely excreted in urine Dosing: Usual Oral: Adolescents and Adults: Dosage must be individualized on the basis of effectiveness and tolerance; do not exceed the maximum recommended dose (use slow titration to prevent or minimize GI effects): Initial: 25 mg 3 times/day; increase in 25 mg/day increments in 2-4 week intervals to maximum dose Maximum dose: Patients 60 kg: 50 mg 3 times/day Patients >60 kg: 100 mg 3 times/day Dosing adjustment in renal impairment: Administration Oral: Administer with first bite of each main meal Monitoring Parameters Fasting blood glucose; hemoglobin A1c; liver enzymes every 3 months for the first year of therapy and periodically thereafter Reference Range Target range: Blood glucose: Fasting and preprandial: 80-120 mg/dL; bedtime: 100-140 mg/dL Glycosylated hemoglobin (hemoglobin A1c): <7% Additional Information Acarbose has been used successfully to treat postprandial hypoglycemia in children with Nissen fundoplications. Six children (4-25 months) initially received 12.5 mg before each bolus feeding of formula containing complex carbohydrates. The dosage was increased in 12.5 mg increments (dosage range: 12.5-50 mg per dose) until postprandial serum glucose was stable 60 mg/dL. Most commonly reported side effects were flatulence, abdominal distension, and diarrhea (Ng, 2001). 40

Related Information
Acetaminophen Serum Level Nomogram on page 1843

U.S. Brand Names Acephen [OTC]; APAP 500 [OTC];

Aspirin Free Anacin Extra Strength [OTC]; Cetafen Extra [OTC]; Cetafen [OTC]; Excedrin Tension Headache [OTC]; Feverall [OTC]; Infantaire [OTC]; Little Fevers [OTC]; Mapap Arthritis Pain [OTC]; Mapap Children's [OTC]; Mapap Extra Strength [OTC]; Mapap Infant's [OTC]; Mapap Junior Rapid Tabs [OTC]; Mapap [OTC]; Nortemp Children's [OTC]; Ofirmev; Pain & Fever Children's [OTC]; Pain Eze [OTC]; Silapap Children's [OTC]; Silapap Infant's [OTC]; Triaminic Children's Fever Reducer Pain Reliever [OTC]; Tylenol 8 Hour [OTC]; Tylenol Arthritis Pain Extended Relief [OTC]; Tylenol Children's Meltaways [OTC]; Tylenol Children's [OTC]; Tylenol Extra Strength [OTC]; Tylenol Infant's Concentrated [OTC]; Tylenol Jr. Meltaways [OTC]; Tylenol [OTC]; Valorin Extra [OTC]; Valorin [OTC] Canadian Brand Names Abenol; Apo-Acetaminophen; Atasol; Novo-Gesic; Pediatrix; Tempra; Tylenol Therapeutic Category Analgesic, Non-narcotic; Antipyretic