Acarbose Side Effects

Acarbose (precose) Side Effects are gas, flatulence, diarrhea, stomach pain, upset abdomen, unusual tiredness, bleeding, jaundice, nausea, vomiting and dark urine.

List of common miner side effects of Acarbose (precose)

  1. Gas
  2. Flatulence
  3. Loose stool
  4. Upset abdomen

Serious side effects of Acarbose

  1. Persistent nausea or vomiting
  2. Severe abdominal pain
  3. Dark urine
  4. Bleeding in stool
  5. Unusual tiredness

Detailed description of Acarbose Side effects

Gastrointestinal system

About 90% patients on acarbose experience gastrointestinal side effects.  These symptoms are usually mild to moderate in intensity and appear around the first few weeks of therapy.  Acarbose binds reversibly to the oligosaccharide binding site of alpha glucosidase enzymes of the mucosa in the upper half of small intestine.  This leads to degradation of starch to glucose and thereby reduces the absorption of glucose.  Due to the presence of carbohydrates in the colon, bacterial fermentation takes place leading to gastro intestinal symptoms like flatulence, loose stools, dyspepsia, tenesmus, abdominal spasms, and abdominal pain.  Diarrhea is caused due to increase in osmotic pressure due to the retention of unabsorbed carbohydrate in the small intestine.  Carbohydrate malabsorption, nausea, vomiting, ileus may also be caused due to acarbose.  Acarbose may also interfere with absorption of other nutrients and minerals leading to nutritional deficiencies like iron deficiency and calcium deficiency.  Pneumotosis cystoides intestinalis is also reported in patients taking acarbose.  Flatulence is the most common side effect and hence patients must be advised to avoid gas producing foods and sucrose.  The combination of metformin with acarbose increases gastrointestinal discomfort as well as acarbose decreases the absorption of metformin.  Hence this combination must be preferably avoided.  Advise the patient not to take activated charcoal, amylase, and pancreatin along with acarbose because it may decrease the effect of acarbose.

Liver (Hepatic)

Reversible increases in hepatic enzymes are noted with the use of acarbose.  This may lead to reversible hepatotoxicity.  Elevated serum transaminases are observed.  Acarbose does not bind to proteins and undergoes no apparent hepatic biotransformation; hence the exact cause of hepatotoxicity remains unclear.  It is thought that it may occur due to renal decompensation which leads to increased systemic exposure, predisposing the patient to toxicity.  Liver function tests must be monitored every 3 months in patients receiving acarbose.


Hypoglycemia may develop in patients receiving acarbose along with insulin or sulfonylurea.  Hypoglycemia caused by acarbose cannot be treated with sucrose because acarbose will impede its hydrolysis and delay absorption, hence in patients taking acarbose, hypoglycemia must be treated with glucose.  Patients must be instructed regarding the signs and symptoms of hypoglycemia and the need to report immediately if they experience such symptoms.  explain to the patient to avoid taking table sugar or sucrose as it does not have any effect on hypoglycemia caused due to acarbose instead  advise patient to use glucose tablets or  take honey or fruit juices because they contain fructose which will help in increasing  the blood sugar.  Once the primary home management has been done, advise the patient to visit the doctor if symptoms of hypoglycemia persist.


Decreased iron absorption from the intestine may cause iron deficiency anemia.

Nervous system

Nervous system side effects are very rarely reported in patients treated with acarbose.  Some that are reported are dizziness, weakness, somnolence, headache, and vertigo.


Hypersensitive skin reaction like rashes, edema, erythema, xanthema, erythema multiforme has been reported with the use of acarbose.

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