A patient taking acarbose with each meal experiences abdominal bloating, flatulence, and loose stools. These effects occur because acarbose:

• A Increases intestinal motility via cholinergic stimulation
• B Causes osmotic diarrhea by blocking sodium-glucose cotransport
• C Leaves undigested complex carbohydrates to be fermented by colonic bacteria ✓
• D Induces bile acid malabsorption in the terminal ileum

Explanation

Acarbose competitively inhibits brush border alpha-glucosidases, delaying conversion of oligosaccharides and disaccharides to absorbable monosaccharides. Carbohydrates reaching the colon are fermented by bacterial flora, producing gas, cramps, and diarrhea. Used alone it cannot cause hypoglycemia because it does not affect insulin secretion. If hypoglycemia occurs while on acarbose plus another agent, oral sucrose will not work and glucose must be given.

Reference: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.