WHAT IS PRECOSE?
Precose, also known as acarbose, is an oral alpha-glucosidase inhibitor used for the treatment of type 2 diabetes mellitus in addition to diet and exercise. Controlling hyperglycemia helps reduce the risk of complications such as kidney damage, loss of limbs, blindness, heart attack, stroke, or nerve problems. Cardiovascular and renal complications are common in diabetes and can significantly impact morbidity and mortality. Precose is not indicated for the treatment of type 1 diabetes.
HOW DOES PRECOSE WORK?
Precose is a complex oligosaccharide. It delays the breakdown of carbohydrates from food, reducing the blood sugar spike after meals. Because blood glucose concentrations are decreased, Precose decreases glycosylated hemoglobin levels (HgA1c). A HgA1c represents the average blood glucose concentration over the past 2 to 3 months.
Precose does not increase insulin release as sulfonylureas do. Precose competitively and reversibly inhibits alpha-amylase and alpha-glucosidase hydrolase enzymes in the pancreas. Alpha amylase in the pancreas breaks starches down into oligosaccharides in the small intestine. Alpha-glucosidases break down oligosaccharides, trisaccharides, and disaccharides to glucose in the small intestine. By blocking this enzyme, Precose delays the absorption of glucose, thus decreasing hyperglycemia after ingesting meals.
The mechanism of Precose differs from that of sulfonylureas. Therefore, Precose can be used in combination with sulfonylureas, insulin, and metformin to potentiate glycemic effects. When used in combination with sulfonylureas, Precose may mitigate associated weight gain and insulinotropic effects. Additionally, Precose does not cause lactose intolerance because it has no impact on lactase.
SIDE EFFECTS
Common side effects include:
- Diarrhea
- Bloating and gas
- Upset stomach
- Abdominal pain
More serious side effects include:
- Unusual fatigue
- Nausea and vomiting
- Serious abdominal or stomach pain
- Eye or skin yellowing
- Dark urine
- Rectal bleeding
WARNINGS AND PRECAUTIONS
Macrovascular Effects
There are no studies that have evaluated the macrovascular risk with Precose use.
Hypoglycemia
Precose should not cause hypoglycemia when used alone. However, when combined with other agents that lower blood glucose levels, Precose can potentiate the hypoglycemic effects of these drugs. Sulfonylureas and insulin, for example, can cause hypoglycemia when administered with Precose. Metformin, when used as monotherapy, does not usually cause hypoglycemia. When used with Precose, there have been no reports of increased susceptibility to hypoglycemia.
In cases of mild to moderate hypoglycemia, oral glucose should be administered. Absorption of oral glucose, or dextrose, is not affected by Precose, making it a good agent to treat low glucose levels. Sucrose, or cane sugar, should not be used as Precose blocks the breakdown of sucrose into glucose and fructose. Therefore, it does not quickly reverse symptoms of hypoglycemia. Serious hypoglycemia should be treated with an infusion of intravenous glucose or a glucagon injection.
Increased Liver Enzymes
Precose has been shown to increase serum transaminases (AST and/or ALT) above the upper limit of normal (ULN). These differences were statistically significant when comparing patients receiving Precose to patients receiving placebo. In patients treated with up to 300 mg of Precose three times daily, 14% of patients had enzyme increases above the ULN. Roughly 6% and 3% of patients had an increase of 1.8 times and 3 times the ULN, respectively. Of patients receiving placebo, 7%, 2%, and 1% experienced these increases, respectively.
Cases of increased transaminases were not serious as they were asymptomatic and reversible. These elevations typically did not indicate underlying liver injury. Incidence was higher in females. AST and ALT elevations were seemingly dose related. Particularly, in doses up to 100 mg three times daily, incidence of transaminase elevations was similar between patients treated with Precose versus patients treated with placebo.
Throughout post marketing experience, Precose has been associated with 62 cases of transaminase elevations greater than 500 IU/L. A total of 29 cases also involved jaundice symptoms. Of these cases, 41 were receiving at least 100 mg of Precose three times daily. Of 45 patients whose weight was documented, 33 patients weighed less than 60 kg. In the 59 reports where follow-up was documented, liver dysfunction resolved upon stopping Precose in 55 patients. In a total of two cases enzyme levels remained unchanged. Additionally, reports of fatal fulminant hepatitis have occurred. However, it is unknown if these incidences involved acarbose.
Loss of Glucose Control
If a patient’s blood glucose is well-controlled but they experience external stress such as surgery, infection, trauma, or fever, their glucose levels may become uncontrolled. In these circumstances, Precose should be discontinued, and insulin should be administered.
DRUG INTERACTIONS
Hyperglycemic Drugs
Medications that can cause hyperglycemia may lead to uncontrolled glucose levels when taken with Precose. If these agents are taken with Precose, the patient’s blood glucose levels should be monitored. If these medications are discontinued while on Precose, the patient should be monitored for signs and symptoms of hypoglycemia. These drugs include diuretics, phenothiazines, corticosteroids, thyroid medications, estrogens, phenytoin, oral contraceptives, nicotinic acid, calcium channel blocking drugs, isoniazid, and sympathomimetics.
Sulfonylureas and insulin can cause hypoglycemia when administered with Precose. If the patient develops hypoglycemia, providers should adjust the dose of the other antidiabetic agents. In rare cases, some patients experience hypoglycemic shock when taking sulfonylureas and/or insulin in combination with Precose. Metformin, when used as monotherapy, does not usually cause hypoglycemia. When used with Precose, there have been no reports of increased susceptibility to hypoglycemia.
Intestinal adsorbents and digestive enzyme preparations
Certain intestinal adsorbents and digestive enzyme preparations may decrease Precose efficacy. Intestinal adsorbents can include charcoal. Digestive enzyme preparations that have carbohydrate-splitting enzymes are also of concern and include amylase or pancreatin. Therefore, these substances are not recommended to be taken together with Precose.
Digoxin
When co-administered with digoxin, Precose has been shown to change digoxin bioavailability and thus digoxin concentrations. Use caution when taking concomitantly and monitor appropriately to avoid digoxin toxicity. Additionally, digoxin may require a change in dose if taken together with Precose.
SPECIAL POPULATIONS
Pregnancy
It is not known if Precose is safe for pregnant women. Animal studies in rats received Precose doses of up to 480 mg/kg and did not demonstrate injury to fertility or the fetus. In rabbits, there were slightly more embryonic losses in rabbits treated with Precose. However, this is likely due to a decrease in weight gain in pregnant rabbits. Additionally, rabbits receiving 160 mg/kg of Precose did not demonstrate embryotoxicity or teratogenicity. However, no well-controlled studies exist that evaluate Precose during pregnancy in humans. Animal studies do not always predict adverse effects in humans, and therefore providers should proceed with caution when using Precose during pregnancy. Uncontrolled blood glucose during pregnancy can lead to congenital problems and neonatal morbidity and mortality. Thus, the benefits and risks of initiating Precose in diabetic, pregnant patients should be considered. Insulin is most commonly used, though, in treating diabetes during pregnancy.
Lactation
Studies evaluated the presence of Precose in animal milk. After administration of radiolabeled acarbose, lactating rats had trace amounts of radioactivity in their milk. This suggests that Precose may be excreted into human milk. Thus, Precose should not be taken by lactating patients.
Pediatrics
Precose has not been studied in pediatric patients. Thus, safety and effectiveness in younger populations have not been confirmed.
Geriatrics
Of all the participants included in Precose clinical studies, 27% of them were over the age of 65 years of age. A total of 4% were over the age of 75. In general, there were no differences between older and younger patients in terms of safety and effectiveness. Precose concentrations were 1.5 times higher in geriatric patients versus younger patients. However, the variance in concentration was not statistically significant.
Cost & Ordering Information
Buy Precose Through Buy Canadian Insulin
Buy Canadian Insulin helps patients access Precose through participating pharmacy partners.
Pricing may vary depending on product strength, quantity selected, supplier availability, and participating pharmacy partner pricing policies.
Some patients may find pricing through participating pharmacy partners that differs from certain U.S. retail pharmacy prices.
Available services may include:
- Pricing options based on quantity selected
- Prescription processing for Precose through participating pharmacy partners
- Shipping options available across eligible U.S. delivery locations
- Ordering support through phone, email, or live chat
- Multiple quantity options depending on prescription authorization and supplier availability
Precose requires a valid prescription from a licensed healthcare provider. Prescriptions are reviewed by licensed pharmacists and healthcare professionals before dispensing, where applicable.
Shipping timelines for Precose may vary depending on prescription review requirements, inventory availability, destination location, and carrier services.
Precose Discounts and Coupons
Eligible first-time customers may use coupon code FIRST10 during checkout for qualifying orders, subject to current promotional terms and conditions.
Have a Prescription for Precose?
Patients may explore available Precose ordering options through participating pharmacy partners.
Available ordering features may include:
- Pricing options based on quantity selected
- Multiple quantity options depending on prescription details
- Shipping options with tracking availability when provided by the carrier
- Customer support assistance through phone, email, or live chat
- Online and phone ordering availability
A valid prescription is required before Precose can be dispensed.
Prescriptions may be uploaded during checkout, emailed, or faxed for pharmacist review.
Pharmacist consultation may be available through participating pharmacy partners when appropriate.
About Buy Canadian Insulin Services
Buy Canadian Insulin works with participating pharmacy partners to help patients access Precose and other prescription products.
Precose availability, pricing, and shipping timelines may vary depending on supplier inventory, participating pharmacy partner availability, and destination location.
Some Precose orders may be fulfilled through licensed pharmacy partners located in Canada or other international fulfillment locations depending on product availability.
Orders are packaged according to pharmacy handling and shipping procedures.
Tracking information may be available when provided by the shipping carrier.
Customer Support & Business Information
For questions regarding Precose availability, prescription processing, shipping timelines, or account support, contact Buy Canadian Insulin customer support:
Phone: 1-888-525-1815
Fax: 1-888-234-1275
Email: info@buycanadianinsulin.com
Customer Support Hours
Monday-Friday: 7am – 10pm CST
Saturday & Sunday: 9am – 5pm CST
Business Address
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Selkirk, MB R1A 4M2
Canada
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Frequently Asked Questions
Disclaimer
Buy Canadian Insulin provides educational information about medications and health conditions for informational purposes only. This content is not intended to replace professional medical advice, diagnosis, or treatment. Prescription medications require valid prescription review and processing through participating pharmacy partners. Product availability, pricing, and shipping timelines may vary. Consult your healthcare provider or pharmacist before starting, stopping, or changing any medication.
