General Information of the drug

• Miglitol works differently from other oral antidiabetes drugs, which control blood sugar levels by increasing the production of insulin or helping the body to use the hormone more efficiently.
• Miglitol delays the digestion of carbohydrates (sugars) by acting in the cells that line the small intestine, where sugar is absorbed. This results in less sugar being absorbed into the blood and therefore, a lower blood-sugar level.
• Miglitol also has some effect against the enzyme lactase, but usually does not cause lactose intolerance. Hypoglycemia (very low blood sugar) is unlikely with miglitol because of the way the drug works in diabetes.
• Miglitol may be prescribed with another antidiabetic drug if single-drug therapy is not enough to adequately control blood sugar levels.



• People taking miglitol should have their blood sugar checked periodically to see how well the drug is working. Your blood glucose should be carefully monitored if you add or withdraw any of these drugs while taking miglitol or acarbose. It is common for patients to equip themselves with Home Glucose Monitors, which is widely available.
• Thiazides and other diuretics, corticosteroid anti-inflammatory drugs, phenothiazines, thyroid drugs, estrogens, contraceptive drugs, phenytoin, nicotinic acid, stimulants, calcium channel blockers, and isoniazid may increase blood sugar levels.
• Miglitol and acarbose add to the blood-sugar-lowering effect of sulfonylureas, insulin, and other antidiabetes drugs and may increase the risk of hypoglycemia (low blood sugar) associated with these drugs.
• Miglitol may interfere with the absorption of several drugs into the blood, including propranolol, ranitidine, digoxin, glyburide, and metformin. Seek advise with your doctor as he/she may need to adjust your dose of these drugs.
• Digestive enzyme preparations, charcoal, kaolin (an ingredient in Kaopectate), and antacids—as well as other drugs intended to absorb stomach contents—reduce the effects of miglitol and acarbose. Separate dosing of these drugs by at least 2 hours.
• Combining acarbose and digoxin may increase the effects of digoxin.
• As Miglitol prevents the breakdown of table sugar, if you take Miglitol in combination with insulin or a sulfonylurea prescription drugs, make sure to have a quick source of glucose (dextrose) with you to treat hypoglycemia ( symptoms include increased hunger, tiredness, sweating, increased heart rate, and numbness in the arms and legs ).
• Take your dose with the first bite of each meal. The drug has to be present in your intestine to prevent the absorption of sugar into your blood.
• As Miglitol cannot work unless there is food in your stomach, if you do forget to take a dose of miglitol with your meal, skip the dose you forgot. At the beginning of your next meal, continue with your regular dose .
• Before buying any nonprescription drug, seek advice with your pharmacist to be sure if it is safe for diabetics to take together with acarbose.

Cautions

• Do not take miglitol if you are sensitive or allergic to any of its ingredients
• If you have diabetic ketoacidosis, cirrhosis of the liver, inflammatory bowel disease, ulcers in the colon, intestinal obstruction, absorption or digestion diseases, or if intestinal gas, it will be a severe problem. Consult your doctor before taking this prescription.
• Acarbose may lead to liver inflammation.
• People with kidney disease retain higher levels of miglitol in the blood, but this does not affect the drug’s action because it acts locally in cells lining the small intestine. For patients with severe kidney disease should not take this drug due to drug retention in the blood.

Dosage and Possible Overdose ( This Prescription is not for Child )

• Acarbose :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol :- Adult: 25-100 mg with breakfast, lunch, and dinner.
• Miglitol must be taken with the first bite of each main meal.
• Unlike other antidiabetic medicines, a miglitol overdose does not cause hypoglycemia. Overdose symptoms are likely to include gas, diarrhea, and pain.
• Follow your doctor’s instructions especially for dietary plan, exercise, and blood- sugar testing. ( See Possible Side Effects below )

Possible Side Effects
a. Acarbose
Intestinal side effects of acarbose tend to improve or go away after a few weeks.
Most common:

• stomach gas (in 75% of people who take it),
• abdominal pain,
• and diarrhea.

( These side effects may be worse if you don’t restrict the amount of carbohydrate in your diet. Consult your doctor on proper dietary plan )

Less common or Rarely Occurs :

• skin rashes.
• swelling and itching,
• hepatitis or yellowing of the skin or whites of the eyes,
• abdominal distress,
• abdominal obstruction,
• liver irritation,
• abnormalities in blood tests.

b. Miglitol ( Most side effects of miglitol go away with continued use of the drug )
Most common:  gas, diarrhea, and abdominal pain.
Less common or Rare Effects : rash and low blood iron.

** For Unusual Side Effects that you may notice, seek your doctor advise immediately !

Pregnancy/Breast-feeding period :
Nursing Mothers who must take this drug should use infant formula, as the safety of using miglitol during pregnancy is not known, but small amounts of miglitol pass into breast milk. ( Diabetes during pregnancy is usually treated with insulin. )

Seniors Adult Consumption
Seniors with severe kidney disease should avoid this medication.

*Blood levels of acarbose are higher in older adults, but this is usually not considered important. Always consult your doctor if in doubt.

• Hypertension ( high blood pressure ),
• heart failure,
• diabetic kidney disease,
• and heart attack treatment ( when the function of the left ventricle has been affected),
• kidney failure,
• kidney hypertension,
• managing people with a high risk of heart disease,
• chronic kidney disease,
• preventing a second stroke.

General Information of the drug

• Enalapril begins working about 1 hour after you take it and continues to work for 24 hours.
• Enalapril maleate and other ACE inhibitors work by preventing the conversion of a hormone called ‘Angiotensin I‘ to another hormone called ‘Angiotensin II‘ , a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving symptoms of heart failure.
• Enalapril also affects the production of other hormones and enzymes that participate in the regulation of blood-vessel dilation.

Cautions

• Enalapril occasionally causes very low blood pressure.
• Do not take enalapril if you are allergic or sensitive to any of its ingredients. Severe sensitivity reactions can occur in hemodialysis patients taking enalapril or those undergoing venom immunization.
• Swelling of the face, extremities, or throat has been known to occur with enalapril, which can be dangerous (see below section on “Important Notes” ).
• Enalapril may affect your kidney function, especially if you have congestive heart failure. Your doctor should check your urine for protein content during the first few months of treatment. Dosage adjustment of enalapril is necessary if you have reduced kidney function.
• Enalapril can affect white-blood-cell counts, possibly increasing your susceptibility to infection. Your doctor should monitor your blood counts periodically.
• Enalapril may cause serious injury or death to the fetus if taken during pregnancy. Pregnant women should not take enalapril.
• ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.

How the Drug works ?

• Antacids and enalapril should be taken at least 2 hours apart.
• The blood-pressure-lowering effect of enalapril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid drop in blood pressure should be used with caution if you are taking enalapril.
• Enalapril may increase the effects of lithium; this combination should be used with caution.
• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the blood-pressure-lowering effects of enalapril and other ACE inhibitors. The combination may cause reductions in kidney function.
• Enalapril may increase blood-potassium levels, especially when taken with dyazide or other potassium-sparing diuretics.
• Capsaicin may trigger or aggravate the cough associated with enalapril therapy.
• Rifampin may reduce the effects of enalapril.
• The combination of allopurinol and enalapril increases the chance of side effects. Avoid this combination as severe sensitivity reactions can occur in those taking allopurinol.
• Enalapril affects blood levels of digoxin. More digoxin in the blood increases the chance of digoxin-related side effects, while less digoxin in the blood can compromise its effectiveness.
• Indomethacin may reduce the blood-pressure-lowering effects of enalapril.
• Phenothiazine sedatives and antiemetics may increase the effects of enalapril.

Important Note

• Enalapril can cause swelling of the face, lips, hands, or feet. This swelling can also affect the larynx (throat) or tongue and interfere with breathing. If this happens, go to a hospital emergency room at once.
• Call your doctor if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, persistent rash, or loss of taste perception.
• Some people who start taking enalapril after they are already on a diuretic (an agent that increases urination) could experience a rapid drop in blood pressure after their first doses or when their dosage is increased. To prevent this from happening, inform your doctor before hand ( that you are taking diuretic ) , as your doctor may tell you to stop taking your diuretic 2 or 3 days before starting enalapril or to increase your salt intake during that time. Upon your doctor advise, you may then restart on taking diuretic gradually.
• You may get dizzy if you rise to your feet too quickly from a sitting or lying position when taking enalapril.
• Avoid strenuous exercise or very hot weather because heavy sweating or dehydration can cause a rapid drop in blood pressure.
• While taking enalapril, avoid over-the-counter diet pills, decongestants, and other stimulants that can raise blood pressure.
• Do not take potassium supplements or salt substitutes containing potassium without consulting your doctor.
• Never take a double dose. If you take enalapril once a day and forget to take a dose, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. If you take enalapril twice a day and miss a dose, take it right away. If it is within 4 hours of your next dose, take 1 dose immediately and another in 5 or 6 hours, then go back to your regular schedule.

Possible Side Effects

Refers to Side Effects on Lexxel Drug , as these drugs works in combination in most treatments condition. However, if you experience unusual effects, do consult your doctor for advise.

Pregnancy/Breast-feeding period :

• ACE inhibitors can cause fetal injury or death. Women who are or might become pregnant should not take ACE inhibitors.
• Sexually active women of childbearing age who must take enalapril must use an effective contraceptive method to prevent pregnancy.
• If you become pregnant, stop taking the medication and call your doctor immediately.
• Nursing mothers who must take this drug should use infant formula as small amounts of enalapril pass into breast milk.

For Seniors who needs to take this drug :-

Seniors may be more sensitive to the effects of enalapril drug due to age-related losses in kidney or liver function.