miglitol

miglitol

(mig' lah tall)

Glyset

Pregnancy Category B

Drug class

Antidiabetic

Alpha-glucosidase inhibitor

Therapeutic actions

An alpha-glucosidase inhibitor that delays the digestion of ingested carbohydrates, leading to a smaller increase in blood glucose following meals and a decrease in glycosylated Hgb; does not enhance insulin secretion and so its effects are additive to those of the sulfonylureas in controlling blood glucose.

Indications

·        Adjunct to diet to lower blood glucose in patients with type 2 (non–insulin-dependent) diabetes mellitus whose hyperglycemia cannot be managed by diet alone

·        Combination therapy with a sulfonylurea to enhance glycemic control in those patients with type 2 diabetes who do not receive adequate control with diet and either drug

Contraindications and cautions

·        Contraindicated with hypersensitivity to the drug; diabetic ketoacidosis; cirrhosis; inflammatory bowel disease; intestinal obstruction or predisposition to intestinal obstruction; type 1 (insulin-dependent) diabetes; conditions that would deteriorate with increased gas in the bowel.

·        Use cautiously with renal impairment, pregnancy, lactation.

Available forms

Tablets—25, 50, 100 mg

Dosages

ADULTS

·        Monotherapy: Initial dose, 25 mg PO tid at the first bite of each meal; may start at 25 mg PO daily if severe GI effects are seen. For maintenance, 50 mg PO tid at first bite of each meal. Maximum dose, 100 mg PO tid.

·        Combination with a sulfonylurea: Blood glucose may be much lower; monitor closely and adjust dosages of each drug accordingly.

PEDIATRIC PATIENTS

Safety and efficacy not established.

Pharmacokinetics

Route	Onset	Peak
Oral	Rapid	2–3 hr

Metabolism: Not metabolized; T_1/2: 2 hr

Distribution: Very little

Excretion: Urine

Adverse effects

·        Dermatologic: Rash

·        Endocrine: Hypoglycemia (taken in combination with other antidiabetic drugs)

·        GI: Abdominal pain, flatulence, diarrhea, anorexia, nausea, vomiting

Interactions

Drug-drug

·        Decreased bioavailability and effectiveness of propranolol, ranitidine

·        Miglitol is less effective if taken with digestive enzymes or charcoal; avoid combining

Drug-alternative therapy

·        Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery

Nursing considerations

Assessment

·        History: Hypersensitivity to the drug; diabetic ketoacidosis; cirrhosis; inflammatory bowel disease; intestinal obstruction or predisposition to intestinal obstruction; type 1 diabetes; conditions that would deteriorate with increased gas in the bowel; renal impairment; pregnancy; lactation

·        Physical: Skin color, lesions; T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation, bowel sounds; urinalysis, BUN, blood glucose

Interventions

·        Give drug tid with the first bite of each meal.

·        Monitor urine or serum glucose levels often to determine effectiveness of drug and dosage.

·        Tell patient abdominal pain and flatulence are likely.

·        Arrange for consult with dietitian to establish weight loss program and dietary control as appropriate. Plan thorough diabetic teaching program to include disease, dietary control, exercise, signs and symptoms of hypoglycemia and hyperglycemia, avoidance of infection, and hygiene.

Teaching points

·        Do not discontinue this medication without consulting your health care provider.

·        Take this drug three times a day with the first bite of each meal.

·        Monitor blood for glucose and ketones as prescribed.

·        Continue diet and exercise program established for control of diabetes.

·        You may experience these side effects: Abdominal pain, flatulence, bloating.

·        Report fever, sore throat, unusual bleeding or bruising, severe abdominal pain.

Adverse effects in Italic are most common; those in Bold are life-threatening