Acarbose is in a class of pharmaceuticals called alpha-glucosidase inhibitors, and works in the intestine, slowing down the digestion of carbohydrates, and lengthening the time it takes for carbohydrates to convert to glucose, thereby facilitating better blood glucose control. It mainly influences the level of blood sugar after eating.

Based on the Product Insert information and other sources, the following is a list of Pro's and Con's about this medication.

Pro's:

• Brings down the blood sugar and glycohemoglobin levels.
• No hypoglycemia if this drug is used as the only diabetic medication.
• Most people will find it easier to lose weight.
• It can be used alone, as the first drug therapy for diabetes (if meal planning and exercise fail to control the blood sugar level), or in combination with any other diabetes pills, including sulfonylureas (such as Glucotrol, Glynase, glyburide, et al), metformin (Glucophage), and/or with insulin by injection.
• It may also help control blood sugar (when used together with insulin) in insulin-dependent (Type I) diabetes.

Con's:

• Mainly affects the postprandial blood sugar (after eating).
• Only a VERY modest decrease in glycohemoglobin at recommended maximal levels of 100 mg. three times daily. There's slightly better control of glycohemoglobin at doses three times as high, but these higher doses are NOT recommended (see below).
• Hypoglycemia, if it occurs in patients on acarbose, MUST be treated with glucose (NOT table sugar, sucrose).
• Most people will suffer "mild-to-moderate" gastrointestinal side effects: pain (21%), diarrhea (33%), and flatulence (77%). It is mentioned that the flatulence "tended to abate with time."
• Combination therapy with metformin (Glucophage), which also has similar gastrointestinal effects, is problematic. Probably this combination should not be tried, except under the care of a physician who is experienced with these medications.
• Correct timing of taking acarbose is important: it should be taken "with the first bite of each main meal."
• The drug must be started in low doses (25 mg three times a day), and the dose gradually adjusted every month or two: "at 4-8 week intervals."
• The starting dose (25 mg three times a day) requires taking a half tablet at each meal, since the smallest tablet made is 50 mg in size.
• The drug is not recommended for people with limited kidney function (creatinine above 2.0 mg/dl), nursing mothers, people with bowel disorders, or simultaneous use with charcoal or digestive enzyme therapy, and has not been studied in children.
• High doses cause abnormal liver enzymes. Therefore, the manufacturer recommends a maximum dose of 100 mg three times daily.
• The cost has not yet been announced (as of January 8, 1996).

Following is the text of the "Information for Patients" in the Product Insert (PD500024, 9/95 © 1995 Bayer Corporation):

Patients should be told to take Precose™ orally three times a day at the start (with the first bite) of each main meal. It is important that patients continue to adhere to dietary instructions, a regular exercise program, and regular testing of urine and/or blood glucose.

Precose™ itself does not cause hypoglycemia even when administered to patients in the fasted state. Sulfonylurea drugs and insulin, however, can lower blood sugar levels enough to cause symptoms or sometimes life-threatening hypoglycemia. Because Precose™ given in combination with a sulfonylurea or insulin will cause a further lowering of blood sugar, it may increase the hypoglycemic potential of these agents. The risk of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be well understood by patients and responsible family members. Because Precose™ prevents the breakdown of table sugar, patients should have a readily available source of glucose (dextrose, D-glucose ) to treat symptoms of low blood sugar when taking Precose™ in combination with a sulfonylurea or insulin.

If side effects occur with Precose™, they usually develop during the first few weeks of therapy. They are most commonly mild-to-moderate gastrointestinal effects, such as flatulence, diarrhea, or abdominal discomfort and generally diminish in frequency and intensity with time.