Acarbose: Adverse reactions, precautions, and manufacturer

Acarbose Adverse reactions:

1.Abdominal bloating, flatulence, and increased bowel sounds:

Acarbose can prolong the breakdown and absorption of food, leading to increased abdominal bloating and flatulence. Starting with a full dose often leads to significant gastrointestinal reactions in new users, so it is recommended to begin with a small dose and gradually increase it. These adverse effects are generally tolerable, and symptoms will alleviate or disappear over time with continued medication. If severe symptoms occur, discontinue the medication immediately. Ingesting carbohydrate-containing foods or beverages after an overdose of acarbose can cause severe gastrointestinal gas and diarrhea. Therefore, it is advisable to avoid carbohydrate-rich foods for 4-6 hours after taking an excessive dose of acarbose.


Hypoglycemia is generally uncommon when acarbose is used alone but may occur when used in combination with insulin, sulfonylureas, or glinides. If hypoglycemia occurs, it should be treated immediately with glucose water, oral glucose tablets, or intravenous glucose infusion. Consumption of sucrose or ordinary sweets (such as biscuits) is ineffective, as acarbose delays the absorption and metabolism of food and sugar, which can slow the rise in blood glucose levels and delay emergency treatment, posing a risk.

3.Liver Injury:

Most of acarbose is degraded in the intestine or excreted unchanged in the feces, with only a small amount (about 1%-2%) being absorbed into the bloodstream. Therefore, it generally does not undergo metabolism in the liver and is unlikely to harm liver function. However, there have been reports of abnormal liver function following medication use. It is recommended that patients undergoing treatment with acarbose have regular liver function tests, especially monitoring changes in aminotransferases during the first 6-12 months. Mild injuries may quickly improve after discontinuing the medication or symptomatic treatment; severe cases may require hospitalization.

9 points to note:

  1. Take it with the first bite of staple food. Acarbose is an alpha-glucosidase inhibitor that works by slowing down the absorption of carbohydrates to lower postprandial blood sugar levels. Therefore, it must be taken with the first bite of staple food; without staple food, it has no effect. If this meal only includes vegetables, meat, eggs, dairy products, and soy products without staple food such as rice, bread, noodles, cakes, potatoes, or corn that mainly contain starch, then Acarbose will hardly play a role and there is no need to take it. Common staple foods include rice, bread, noodles, cakes, potatoes, corn, etc.
  2. Chewable tablet and swallow capsule: The Acarbose tablets should be chewed well before eating with staple food to mix the drug more thoroughly with the food and speed up the rate and extent of reducing postprandial blood sugar levels. The Acarbose capsule should be swallowed whole with the staple food without chewing.
  3. If forgotten to take, take within 30 minutes after meals. If you remember that you forgot to take Acarbose after finishing your meal but within 30 minutes after eating, you can take the missed dose at the original dosage. If more than 30 minutes have passed since your last meal, do not take a double dose; instead, take it at the normal dose for the next meal. If you remember missing a dose during a meal, you can take it immediately. If an excessive amount of Acarbose is taken, do not eat staple foods for 4-6 hours afterward.
  4. Do not stop taking if experiencing gastrointestinal discomfort: When taking Acarbose, if only gastrointestinal discomfort occurs (such as frequent bowel movements, abdominal bloating, diarrhea, nausea, or decreased appetite), do not stop taking the medication. These adverse reactions mainly occur in the early stages of medication use and may gradually improve or disappear after one or two months. You can also try massaging or applying hot compresses to the abdomen to relieve discomfort. If severe gastrointestinal discomfort or other symptoms occur, seek medical attention or consult a doctor promptly.
  5. Start with a low dose to reduce side effects: To minimize or alleviate gastrointestinal discomfort and other adverse reactions, it is recommended to start with a low dose and gradually increase it. The starting dose of Acarbose is 50 mg per dose, which can be gradually increased to 100 mg per dose; generally, three doses per day are taken. In some cases, it can be increased to 200 mg per dose.
  6. Do not eat staple foods if hypoglycemia occurs when taking Acarbose: Acarbose itself does not cause hypoglycemia; if hypoglycemia occurs when used in combination with other oral blood sugar-lowering medications or insulin, it should be treated immediately by eating glucose or honey instead of sucrose or starchy foods. Sucrose or starchy foods belong to complex carbohydrates; Acarbose can delay their sugar absorption and cannot rapidly raise low blood sugar levels. Therefore, it is essential to remember this!
  7. Safe for liver and kidney function: Since Acarbose mainly acts in the intestinal tract and only about 2% is absorbed into the bloodstream, it has little impact on liver and kidney function. Rare cases of liver function abnormalities have occurred; patients with elevated transaminase levels should exercise caution when using Acarbose. Patients with impaired liver function should use it cautiously. When using Acarbose alone for blood sugar control, it rarely causes hypoglycemia. Therefore, it can be used with confidence.
  8. Combination therapy for patients with poor pancreatic function: If a patient’s pancreatic function is poor and taking Acarbose alone cannot achieve postprandial blood glucose control goals; consider combining it with other antidiabetic drugs such as metformin; this not only improves blood sugar control effectiveness but also reduces side effects.
  9. Long-term use suggests vitamin supplementation: Long-term use of Acarbose may lead to deficiencies in B vitamins (such as vitamin B12), vitamin C, and folic acid among others that are water-soluble vitamins. Therefore, patients who take Acarbose for a long time are advised to consume foods rich in B vitamins and vitamin C in moderation and consider taking dietary supplements if necessary.”

Manufacturers in the United States

  • 1.Bayer HealthCare Pharmaceuticals Inc.
  • 2.Aurobindo Pharma Limited
  • 3.Cipla Limited
  • 4.Dr. Reddy’s Laboratories Ltd.
  • 5.Hikma Pharmaceuticals USA Inc.
  • 6.Lupin Pharmaceuticals, Inc.
  • 7.Mylan Pharmaceuticals Inc.
  • 8.Sun Pharmaceutical Industries Inc.
  • 9.Teva Pharmaceuticals USA Inc.
  • 10.Zydus Pharmaceuticals (USA) Inc.

The price can vary depending on the manufacturer and the dosage form. On average, the price in the United States ranges from 10-50 for a 30-day supply.

The market size in the United States is significant. According to a report by Grand View Research, the global Acarbose market size was valued at USD 820.5 million in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 5.5% from 2020 to 2027. The United States is one of the largest markets for Acarbose, driven by the increasing prevalence of diabetes and the growing awareness of the importance of blood glucose control.

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