MIGLITOL
(mig'li-tol)
Glyset
Classifications: hormones and synthetic substitutes; antidiabetic agent; alpha-glucosidase inhibitor
Prototype: Acarbose
Pregnancy Category: B

Availability

25 mg, 50 mg, 100 mg tablets

Actions

Enzyme inhibition of intestinal glucosidases that delays the formation of glucose from saccharides in the small intestine. Miglitol does not enhance insulin secretion.

Therapeutic Effects

It delays the digestion of carbohydrates, lowers the postprandial hyperglycemia, and reduces the levels of glysylated hemoglobin (HbA_1C) in type 2 diabetics.

Uses

Adjunct to diet for control of type 2 diabetes; may be used alone or with a sulfonylurea.

Contraindications

Diabetic ketoacidosis; digestive or absorptive disorders; history of or partial intestinal obstruction, inflammatory bowel disease; hypersensitivity to miglitol; lactation.

Cautious Use

Hypersensitivity to acarbose; creatinine clearance above 2 mg/dL; concomitant use with sulfonylurea; high stress conditions (i.e., surgery, trauma, etc.); pregnancy (category B). Safety and efficacy in children <18 y unknown.

Route & Dosage

Type 2 Diabetes Mellitis
Adult: PO 25 mg t.i.d. at the start of each meal, may increase after 4–8 wk to 50 mg t.i.d. (max: 100 mg t.i.d.)

Administration

Oral

Give drug with first bite of each of the three main meals.
Store at 15°–30° C (59°–86° F).

Adverse Effects (1%)

GI: Abdominal pain, diarrhea, flatulence. Skin: Rash. Metabolic: Hypoglycemia.

Interactions

Drug: Miglitol may reduce bioavailability of propranolol, ranitidine; charcoal, pancreatin, amylase, pancrelipase may decrease effectiveness of miglitol. Herbal: Garlic, ginseng may potentiate hypoglycemic effects.

Pharmacokinetics

Absorption: 25 mg dose is completely absorbed, amount absorbed decreases with increasing dose to where 100 mg dose is 50–70% absorbed. Peak: 2–3 h. Distribution: Minimal protein binding (<4%). Metabolism: Not metabolized. Elimination: Half-life 2 h; 95% excreted unchanged in urine, lower doses should be used in patients with renal impairment.

Nursing Implications

Assessment & Drug Effects

Monitor for therapeutic effectiveness: Indicated by improved blood glucose levels and decreased HbA_1C.
Monitor for S&S of hypoglycemia when used in combination with sulfonylureas, insulin, other hypoglycemia agents.
Lab tests: Monitor HbA_1C q3mo.
Treat hypolgycemia with oral glucose (dextrose); miglitol interferes with the breakdown of sucrose (table sugar).

Patient & Family Education

Keep a source of oral glucose available to treat low blood sugar; miglitol prevents digestive breakdown of table sugar.
Abdominal discomfort, flatulence, and diarrhea tend to diminish with continued therapy.
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug