Names and pronunciation
(mig′lih-tol) M Glyset
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Drug reference
(mig′lih-tol) M Glyset
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Func. class.: Oral hypoglycemic
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Chem. class.: α-Glucosidase inhibitor
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ACTION: Delays digestion and absorption of ingested carbohydrates, which results in a smaller rise in blood glucose after meals; does not increase insulin production
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USES: Type 2 diabetes mellitus
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Unlabeled uses: Type 1 diabetes mellitus
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CONTRAINDICATIONS: Hyper- sensitivity, diabetic ketoacidosis, cirrho- sis, inflammatory bowel disease, colonic ulceration, partial intestinal obstruction, chronic intestinal disease, ileus Precautions: Pregnancy, breastfeeding, children, diarrhea, hiatal hernia, hypo- glycemia, renal disease, type 1 diabetes, vomiting
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SIDE EFFECTS GI: Abdominal pain, diarrhea, flatulence, hepatotoxicity INTEG: Rash
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INTERACTIONS Increase: hypoglycemia risk—insulin, other antidiabetics Decrease: levels of digoxin, propranolol, raNITIdine; adjust dose as needed Decrease: miglitol levels—digestive enzymes, intestinal adsorbents; do not use together Drug/Food Increase: diarrhea—carbohydrates
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DOSAGE AND ROUTES • Adult: PO 25 mg tid initially, with 1st bite of meal; maintenance dose may be increased to 50 mg tid; may be increased to 100 mg tid if needed with dosage ad- justment at 4- to 8-wk intervals
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Available forms: Tabs 25, 50, 100 mg
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Administer: • Tid with first bite of each meal • Store in tight container at room tem- perature
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Assess: • Hypo/hyperglycemia; even though product does not cause hypoglycemia, if patient receiving sulfonylureas or insulin, hypoglycemia may be additive (rare) • Blood glucose levels, hemoglobin, A1c, LFTs; if hypoglycemia occurs with monotherapy, treat with glucose • Identify medical regimen pre- scribed—diet, exercise, lab work • Monitor blood glucose testing more often in stress, trauma, surgery • Pregnancy/breastfeeding: use of insu- lin during pregnancy is recommended, don’t use this product unless clearly needed; excreted in breast milk, avoid use
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Evaluate: • Therapeutic response: decreased signs, symptoms of diabetes mellitus (polyuria, polydipsia, polyphagia; clear sensorium, absence of dizziness; stable gait); improved blood glucose, A1c
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the symptoms of hypo/hypergly- cemia; what to do about each; that during periods of stress, infection, or surgery, insulin may be required • To carry oral glucose or glucagon to treat low glucose, do not use simple sugar in fruit juices, candy, table sugar • How to use a glucose monitor and when to monitor; how to identify low blood glucose levels • That medication must be taken as pre- scribed, tid with first bite of each meal; about consequences of discontinuing medication abruptly • To avoid OTC medications unless ap- proved by health care provider • That diabetes is lifelong; that product is not a cure; to continue with medical regimen of diet, exercise, lab work • To carry ID for emergency purposes • About GI side effects that are com- mon during several weeks of treat- ment, that they improve with continued treatment HIGH ALERT
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PHARMACOKINETICS Peak 2-3 hr, not metabolized, excreted in urine as unchanged product, half-life 2 hr
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• Adult: PO 25 mg tid initially, with 1st bite of meal; maintenance dose may be increased to 50 mg tid; may be increased to 100 mg tid if needed with dosage ad- justment at 4- to 8-wk intervals
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