Miglitol
Miglitol (Glyset)
Miglitol
(MIG-lih-tohl)
Pregnancy Category: B Glyset (Rx)

Classification: Antidiabetic, oral

See Also: See also Antidiabetic Agents.

Action/Kinetics: Acts by delaying digestion of ingested carbohydrates resulting in smaller rise in blood glucose levels after meals. Effect is due to reversible inhibition of membrane-bound intestinal glucoside hydrolase enzymes which hydrolyze oligosaccharides and disaccharides to glucose and other monosaccharides. Reduces levels of glycosylated hemoglobin in type II diabetes. Does not enhance insulin secretion or increase insulin sensitivity. Does not cause hypoglycemia when given in fasted state. Absorption is saturable at high doses (i.e., only 50% to 70% of 100 mg dose is absorbed while 25 mg dose is 100% absorbed). Peak levels: 2-3 hr. Drug is not metabolized and is eliminated unchanged in urine. Reduce dose in impaired renal function.

Uses: Alone as adjunct to diet to treat non-insulin-dependent diabetes. With sulfonylurea when diet plus either miglitol or a sulfonylurea alone do not result in adequate control (effects of sulfonylurea and miglitol are additive).

Contraindications: Lactation, diabetic ketoacidosis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, those predisposed to intestinal obstruction, chronic intestinal diseases associated with marked disorders of digestion or absorption, conditions that may deteriorate due to increased gas formation in the intestine, hypersensitivity to drug.

Special Concerns: When given with sulfonylurea or insulin, miglitol causes further decrease in blood sugar and increased risk of hypoglycemia. Safety and efficacy have not been determined in children.

Side Effects: GI: Flatulence, diarrhea, abdominal pain, soft stools, abdominal discomfort. Dermatologic: Skin rash (transient).

Drug Interactions: Amylase / Miglitol effect Charcoal / Miglitol effect Digoxin / May plasma digoxin levels Pancreatin / Miglitol effect Propranolol / Significant propranolol bioavailability Ranitidine / Significant ranitidine bioavailability

How Supplied: Tablets: 25 mg, 50 mg, 100 mg

Dosage
•Tablets Type II diabetes.
Individualize dosage. Initial: 25 mg t.i.d. with first bite of each main meal (some may benefit from starting with 25 mg once daily to minimize GI side effects). After 4 to 8 weeks of 25 mg t.i.d. dose, increase dosage to 50 mg t.i.d. for about 3 months. Measure glycosylated hemoglobin; if not satisfactory, increase dose to 100 mg t.i.d. Maintenance: 50 mg t.i.d., up to 100 mg t.i.d. (maximum).