Voglibose - Uses, Dosage, Administration, Side Effects, and Contraindications

Overview

Voglibose is an alpha-glucosidase inhibitor used for treating diabetes mellitus. The drug was originally discovered in 1981 in Japan, and later, it was used as a commercial treatment for diabetes mellitus in Japan in 1994. The drug is approved by the FDA (Food and Drug Administration) for the treatment of type 2 diabetes mellitus, but its use in gestational diabetes and type 1 diabetes mellitus is still not approved by the FDA.

Uses of Voglibose

Voglibose is used for treating type-2 diabetes mellitus, especially when other medications are ineffective in controlling blood glucose levels. It is indicated in the following conditions:

• Prevention of diabetes mellitus.

• In combination therapy with other oral hypoglycemic agents.

• Prevention of type-2 diabetes mellitus.

• In diabetes mellitus patients, in addition to Insulin.

Dose and Administration

The doctor usually prescribes Voglibose 0.2 mg (milligram) dose thrice a day before each meal. However, if the desired glycemic control is not achieved with a 0.2 mg dosage, the doctor can change the dose to 0.3 mg. It should be noted that the total prescribed dose should not be more than 0.6 mg thrice a day. The drug dosage differs for each person depending on the gastrointestinal tolerance and efficacy of the drug. The oral tablets of Voglibose are consumed by disintegrating into the mouth and then swallowed or as advised by the doctor.

Uses In Specific Population

Pregnant Woman

There are no clinical studies done for the establishment of the safety of Voglibose in pregnant women. Also, no animal studies suggest any potential harm caused by the drug related to pregnancy, fetal growth, and development. Therefore, the drug should only be prescribed to pregnant women if the potential benefits of the drug on the mother overcome the harmful effects on the fetus.

Breastfeeding Woman

Voglibose should be given to a lactating woman only if it is important and unavoidable, as it can reach human milk in a very small amount but can cause body weight increase in babies due to its suppressive action. It can cause suppression of human milk production by reducing the absorption of carbohydrates in the body.

Pediatric Patient

The safety and efficacy of the drug have not been established in young patients. Therefore, the drug should be avoided in the pediatric population.

Geriatric Patients

Due to psychological hypofunction present in geriatric patients, the drug should be started with a lower dosage. Also, the drug should be prescribed to this population under continuous monitoring for gastrointestinal symptoms and blood sugar levels during the entire course of the disease.

Renal Impairment Patients

No adjustment of dose is required for patients with renal impairment because the drug gets poorly absorbed through oral administration and thus is negligibly found in renal excretion.

Gastrointestinal Disorders

Voglibose should be cautiously used in diarrheal diseases as it can be ineffective due to less transit time. Also, systemic absorption of the drug may take place due to ulceration of the gastrointestinal tract caused by bloody diarrhea. In addition, the drug may also cause digestion and absorption disturbances in patients with chronic intestinal diseases.

Metabolic or Endocrine Disorders

Hypoglycemia may occur in patients suffering from endocrine disorders during Voglibose therapy.

For Patients:

What Is Voglibose?

Voglibose is an anti-diabetic drug used for treating diabetes mellitus by lowering blood glucose levels. The drug causes a delay in sugar absorption in the body and, therefore, minimizes the risk of macrovascular complications.

What Is Diabetes Mellitus?

Diabetes mellitus is a metabolic disease that causes too much increase in blood sugar levels. It is a metabolic disorder causing elevated blood sugar levels of various types, such as type 1, type 2, gestational diabetes, MODY or maturity-onset diabetes of the young, neonatal diabetes, and diabetes due to secondary causes, such as steroid use, or endocrinopathies.

How Should this Drug Be Used?

Voglibose 0.2 mg should be taken orally by adult patients thrice a day before each meal. The dosage of the drug is altered or changed according to the patient's condition and the severity of the disease. Therefore, a person should take this drug with a doctor’s consultation.

What Precautions Should Be Taken Before Starting Voglibose?

• A person should inform the doctor about any allergic reaction to this medication, any other drug, or any ingredient present in this drug.

• A person should also inform the doctor about any past or present medical history, such as inflammatory disease, intestinal obstruction, diabetic hypersensitivity, digestive disorders, ketosis, and ulcers.

• A doctor should also be informed about all the non-prescription or prescription drugs, such as herbal products, vitamins, and nutritional supplements, that a person is taking or is planning to take to avoid any drug interactions.

• One must also inform the doctor about the medication prescribed to them before undergoing any dental procedure or any other minor surgery.

• This medication should be used in pregnancy only when its potential benefits outweigh the potential risks. There, a person should discuss taking this medication during pregnancy to manage diabetes.

• Also, a person taking this medication should avoid alcohol as it can cause low blood sugar levels.

• Low or high blood sugar levels can cause blurred vision, drowsiness, or dizziness. Therefore, one must avoid driving and operating heavy machinery or any other such activities that require clear vision and alertness.

What Are the Side Effects of Voglibose?

• Nausea.

• Vomiting.

• Diarrhea.

• Abnormal liver function.

• Dizziness.

• Skin rash.

• Flatulence.

• Pneumatosis intestinalis.

• Abdominal pain.

Overdose:

An accidental overdose of Voglibose can occur if a person takes more than the prescribed drug dose. It can lead to adverse drug effects, and a person may also need immediate medical help.

Missed Dose:

If a person misses the dose of Voglibose, they should take it as soon as they remember. But if it is already time for the next scheduled dose, then the missed dose should be skipped to avoid taking a double dose of the drug. Two doses have a higher potential of causing adverse effects.

Drug Storage and Disposal:

The drug should be kept away from heat, sunlight, and air. It should be stored away from children’s reach in a safe place. The drug should be stored at a room temperature of about 68 to 77 degrees Fahrenheit or 20 to 25 degrees Celsius.

For Doctors:

Clinical Pharmacology

Mechanism of Action:

The drug reversibly and competitively inhibits or interferes with alpha-glucosidase enzymes, such as sucrose, maltase, glucoamylase, and isomaltase at the small intestinal borders. These enzymes are necessary for the decomposition or hydrolysis of complex carbohydrates, such as polysaccharides, starch, disaccharides, and dextrin, into simple forms of carbohydrates. The inhibition of these alpha-glucosidase enzymes causes a delay in glucose absorption in the blood and thus improves post-prandial hyperglycemia.

Pharmacodynamics:

The drug Voglibose acts in the intestinal tract by converting complex carbohydrates into a simple form. The action of the drug mainly depends on the inhibition of intestinal enzymes that cause the degradation of oligosaccharides, disaccharides, and polysaccharides into simple monosaccharides. The digestion of complex carbohydrates is very slow, and therefore, there is also a delay in the release of monosaccharides, which in turn causes its slow absorption in the bloodstream. This further causes less glucose absorption in the blood and thereby leads to reduced postprandial-rich blood glucose levels in the body.

Pharmacokinetics

• Absorption: The drug is poorly absorbed after oral administration. Plasma concentration of Voglibose after oral intake has been undetectable in urine and plasma.

• Distribution: The active unchanged Voglibose remains in the gastrointestinal tract’s lumen and exerts its pharmacological activity.

• Metabolism: Voglibose is metabolized by microbial flora and intestinal enzymes.

• Elimination: The drug gets excreted in the feces.

Ingredients

• Active Ingredients: Voglibose.

• Inactive Ingredients: Mannitol, colloidal silicon dioxide, magnesium stearate, corn starch, and Povidone.

Dose Form and Strength:

• Dosage Form: Tablet.

• Dosage Strength: Voglibose tablet 0.2 mg and 0.3 mg.

Adverse Effects:

• Hypersensitivity - In case pruritus or rash occurs, the drug should be discontinued by consulting the doctor immediately.

• Hypoglycemia - This usually happens when Voglibose is used in combination therapy with other antidiabetic drugs. In such cases, consult the healthcare provider for dose management.

• Gastrointestinal Effects - Abdominal pain, diarrhea, vomiting, nausea, constipation, heartburn, and loose stools may also occur with Voglibose. The drug can also cause symptoms of gastrointestinal obstruction, and abdominal distention caused due to an intestinal gas buildup. Consult the doctor if these symptoms occur.

• Hematological Effects - Leukopenia, anemia, and thrombocytopenia may also be caused by Voglibose. Doctors should monitor the patient for these hematological effects while prescribing Voglibose.

• Hepatic Effects - Voglibose administered to a person with liver cirrhosis may experience worsening constipation due to hyperammonemia, which further causes disturbance of consciousness.

• Psychoneurological Effects - The drug rarely causes headaches.

Drug Interactions:

• Drugs Affecting Glycemic Control: Caution should be taken while concomitantly administering Voglibose to diminish or enhance the action of the drug. Drugs that enhance the hypoglycemic action of these antidiabetic drugs are thyroid hormone, epinephrine, and adrenocortical drugs. The drugs that diminish the hypoglycemic action of antidiabetic drugs include monoamine oxidase inhibitors, salicylic acid derivatives, alpha-blockers, and fibrate derivatives.

• Anti-Diabetic Drug: When the drug is used along with Insulin, sulfonyl amide, and biguanide, a person may experience hypoglycemic symptoms caused by Voglibose. Therefore, one must be cautious about using Voglibose along with these drugs and start the medication from a lower dosage.

• Warfarin: The drug does not cause any effects on the pharmacokinetics of Warfarin; therefore, it is safe to use them in combination.

Contraindications:

The drug is contraindicated in the following conditions:

• Diabetic coma or diabetic ketoacidosis.

• Gastrointestinal obstruction or any predisposed factor.

• Hypersensitivity reaction to the drug or any of its formulation components.

• Severe trauma or infection, pre or post-surgery.