Glucobay (Acarbose)
Also sold as: Glucobay, Carbose, Precose, Glumida, Acarb
Pregnancy
Cat B
Lactation
Caution
Schedule
H
Forms
Tablet 25mg, 50mg, 100mg
Indications
- Type 2 diabetes — monotherapy or add-on, particularly for post-meal hyperglycaemia
- Impaired glucose tolerance (IGT) — prevention of T2DM progression
Adult Dosing
T2DM
Start 25 mg PO TDS with first bite of each main meal; increase by 25 mg every 4-8 weeks to 50-100 mg TDS
Chew with first bite of food or swallow whole with a little water just before meal. Start LOW to minimise GI side effects.
Pediatric Dosing
No paediatric indication
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl > 25 mL/min | No adjustment |
| CrCl < 25 mL/min | AVOID — drug and metabolites accumulate |
Hepatic Adjustment
AVOID in significant hepatic impairment or cirrhosis — hepatotoxicity risk (LFT elevation at higher doses)
Pregnancy & Lactation
Pregnancy: Category B
Minimal systemic absorption; limited human data. Insulin preferred in pregnancy.
Lactation: Caution
Minimal systemic absorption. Small amounts in breast milk. Likely safe but insufficient data.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Digestive enzyme preparations (amylase, pancreatin) | Reduce acarbose effect — avoid combinations | Moderate |
| Adsorbents (cholestyramine, antacids with Mg/Al) | Reduce acarbose effect — separate by 2 hours | Moderate |
| Insulin / Sulfonylureas | Hypoglycaemia risk — acarbose alone does not cause hypoglycaemia | Moderate |
| Metformin | May reduce metformin bioavailability slightly | Minor |
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Side Effects
Common
- Flatulence (very common — dose-dependent; fermentation of undigested carbohydrates in colon)
- Abdominal bloating and cramping
- Diarrhea (especially early)
Serious / Discontinue If
- Hepatotoxicity (elevated transaminases — especially >100 mg TDS; monitor LFTs)
- Intestinal obstruction or sub-obstruction (rare, if bowel motility issues)
Contraindications
- Inflammatory bowel disease (IBD)
- Colonic ulceration
- Intestinal obstruction
- Predisposition to intestinal obstruction
- CrCl < 25 mL/min
- Hepatic cirrhosis
- Chronic intestinal disease with malabsorption
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Glucobay 50mg | Bayer | 30 tab ₹145 |
| Carbose 50mg | Sun Pharma | 30 tab ₹98 |
| Glumida 50mg | Cipla | 30 tab ₹92 |
Monitoring Required
- Post-meal blood glucose (1-2 hours) — this drug specifically targets post-prandial glucose
- HbA1c (3-6 monthly)
- LFTs (baseline and every 3 months for first year, especially at doses > 50 mg TDS)
Patient Counseling Points
- Take with the FIRST BITE of each main meal — not before or after
- GI side effects (gas, bloating) are very common initially — start low (25 mg), increase slowly
- GI symptoms usually improve after 2-4 weeks as gut bacteria adapt
- Hypoglycaemia from acarbose alone is unlikely — but if combined with insulin/sulfonylurea: treat with GLUCOSE (glucose tablets, juice) NOT sucrose (table sugar) — acarbose blocks sucrose digestion
- If you experience severe stomach pain — stop and see doctor (intestinal obstruction risk)
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Clinically reviewed by: Dr. Meena Reddy, DM (Endocrinology), Senior Diabetologist
Last reviewed: 2026-04-01
References
- BNF — Acarbose
- ADA Standards of Care 2025
- RSSDI India Guidelines 2023
- STOP-NIDDM Trial