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Acarbose is metabolized exclusively within the gastrointestinal tractprincipally by intestinal bacteriabut also by digestive enzymesA fraction of these metabolitesapproximately 34of the dosewas absorbed and subsequently excreted in the urineAt least 13 metabolites have been separated chromatographically from urine specimensThe major metabolites have been identified as 4-methylpyrogallol derivativesthat issulfatemethyland glucuronide conjugatesOne metaboliteformed by cleavage of a glucose molecule from acarbosealso has alpha-glucosidase inhibitory activityThis metabolitetogether with the parent compoundrecovered from the urineaccounts for less than 2of the total administered dose.

Caution with drugs that cause hyperglycemiaegdiureticssteroidsestrogensphenothiazinesthyroid productsphenytoinniacinsympathomimeticscalcium channel blockersisoniazidAntagonized by intestinal adsorbentsegcharcoalpancreatinamylaseother carbohydrate-splitting enzymesMonitor digoxinand for hypoglycemia if used with insulin or a sulfonylureaMay result in unreliable measurements of 1,5-AG assayuse alternative methods to monitor glycemic control.

If you take acarbose with insulin or other diabetes medicationsyour blood sugar could get too lowLow blood sugarhypoglycemiacan occur if you skip a mealexercise too longdrink alcoholor are under stressSymptoms include headachehungerweaknesssweatingtremorsirritabilityor trouble concentrating.

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