miglitol

Absorption: Completely absorbed at lower doses (25 mg); 50–70% absorbed at higher doses (100 mg).

Distribution: Distributes primarily into extracellular fluid; small amounts enter breast milk.

Metabolism/Excretion: Not metabolized; action is primarily local in the GI tract; amounts that are absorbed are excreted mostly unchanged in urine.

Half-Life: 2 hr.

Time/Action Profile ⬆ ⬇

(effect on glucose absorption)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	within 1 hr	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Diabetic ketoacidosis;
Inflammatory bowel disease or other chronic intestinal conditions resulting in impaired absorption or predisposition to obstruction;
Lactation: Lactation.

Use Cautiously in:

Patients with fever, infection, trauma, or stress (may cause hyperglycemia requiring alternate therapy);
Renal impairment (use not recommended if creatinine >2 mg/dL);
OB: Pedi: Safety not established.

Adv. Reactions/Side Effects ⬆ ⬇

GI: abdominal pain, diarrhea, flatulence

Hemat: low serum iron

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of propranolol.
Effects may be ↓ by intestinal adsorbents (such as charcoal) and digestive enzyme products; concurrent use should be avoided.

Concurrent carbohydrates may ↑ diarrhea.

Route/Dosage ⬆ ⬇

PO (Adults ): 25 mg 3 times daily; may begin with 25 mg once daily; may be ↑ up to 100 mg 3 times daily.

Availability ⬆ ⬇

Tablets: 25 mg; 50 mg; 100 mg

Assessment ⬆ ⬇

Observe patient for signs and symptoms of hypoglycemic reactions (sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety), especially when taking concurrently with other oral hypoglycemic agents.

Lab Test Considerations:

Serum glucose and glycosylated hemoglobin levels should be monitored periodically throughout therapy to evaluate effectiveness of therapy.

Toxicity and Overdose:

Symptoms of overdose are transient increase in flatulence, diarrhea, and abdominal discomfort. Miglitol alone does not cause hypoglycemia; however, other concurrently administered hypoglycemic agents may produce hypoglycemia requiring treatment. Mild hypoglycemia may be treated with administration of oral glucose.

Implementation ⬆ ⬇

Patients stabilized on a diabetic regimen who are exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.
- Does not cause hypoglycemia when taken while fasting but may increase hypoglycemic effect of other hypoglycemic agents.
PO: Administer miglitol 3 times daily with the first bite of each meal. Dose may be started lower and increased gradually to minimize GI effects.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take miglitol at the same time each day, exactly as directed.
- Explain to patient that miglitol helps control hyperglycemia but does not cure diabetes. Therapy is usually long term.
- Encourage patient to follow prescribed diet, medication, and exercise regimen to prevent hyperglycemic or hypoglycemic episodes.
- Review signs of hypoglycemia and hyperglycemia with patient. If hypoglycemia occurs, advise patient to take a glass of orange juice, 2–3 tsp of sugar, honey, or corn syrup dissolved in water, and notify health care professional.
- Instruct patient in proper testing of blood glucose or urine ketones. These tests should be monitored closely during periods of stress or illness and health care professional notified of significant changes.
- Insulin is the recommended method of controlling blood glucose during pregnancy. Counsel female patients to use a form of contraception other than oral contraceptives and to notify health care professional promptly if pregnancy is planned or suspected.
- Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
- Advise patient to carry a form of oral glucose (dextrose, d-glucose) and identification describing disease process and medication regimen at all times.
- Emphasize the importance of routine follow-up exams and regular testing of blood glucose and glycosylated hemoglobin.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇