Voglibose

• Type 2 Diabetes Mellitus:
• Adjunct therapy to diet and exercise to improve postprandial hyperglycemia by delaying carbohydrate absorption.
• Prevention of Type 2 Diabetes Mellitus:
• Used in patients with impaired glucose tolerance (IGT) to reduce progression to overt diabetes.
• Off-label Uses (Clinically Accepted):
• Management of postprandial hyperglycemia in early-stage type 2 diabetes.
• Sometimes combined with other oral hypoglycemics for improved glycemic control.

• Adults:
• Initial dose: 0.2 mg orally three times daily before each main meal.
• Dose may be increased up to 0.3 mg three times daily based on response and tolerance.
• Elderly:
• Use standard adult dosing with caution; monitor for gastrointestinal tolerance.
• Pediatrics:
• Safety and efficacy not established; generally not recommended.
• Special Populations:
• Renal impairment: No dose adjustment generally required, but caution advised in severe impairment.
• Hepatic impairment: Use with caution; no formal dose adjustment guidelines.
• Administration Route:
• Oral tablets taken shortly before meals to optimize delay of carbohydrate absorption.
• Duration:
• Long-term use as part of diabetes management plan.

Voglibose is a potent, selective alpha-glucosidase inhibitor that competitively and reversibly inhibits intestinal enzymes—mainly alpha-glucosidase and pancreatic alpha-amylase—responsible for breaking down complex carbohydrates into absorbable monosaccharides. By delaying carbohydrate digestion and absorption in the small intestine, voglibose reduces postprandial blood glucose excursions, thereby improving overall glycemic control without directly stimulating insulin secretion.

• Absorption: Poor systemic absorption; acts locally in the gastrointestinal tract.
• Distribution: Minimal systemic distribution due to low bioavailability.
• Metabolism: Negligible systemic metabolism due to poor absorption.
• Elimination: Primarily excreted unchanged in feces; negligible renal excretion.
• Onset: Effects evident within hours of administration with meals.
• Half-life: Not well defined due to minimal systemic exposure.

• Pregnancy:
• No adequate human studies. Use only if potential benefits justify potential risks.
• Animal studies have not shown direct teratogenic effects but data are limited.
• Lactation:
• Unknown if excreted in human milk; caution advised. Avoid use unless clearly needed.

• Primary Class: Antidiabetic Agent
• Subclass: Alpha-glucosidase inhibitor

• Known hypersensitivity to voglibose or formulation excipients.
• Diabetic ketoacidosis.
• Inflammatory bowel disease (e.g., ulcerative colitis, Crohn’s disease).
• Intestinal obstruction or predisposition to intestinal obstruction.
• Severe renal or hepatic impairment (relative contraindication).
• Conditions causing malabsorption or intestinal disorders.

• Use cautiously in patients with gastrointestinal diseases, as voglibose may exacerbate symptoms.
• Monitor for hypoglycemia when used with insulin or sulfonylureas; voglibose alone does not cause hypoglycemia.
• Discontinue if severe abdominal symptoms occur (e.g., pain, distension, diarrhea).
• Educate patients to recognize signs of hypoglycemia and treat promptly.
• Periodic liver and renal function monitoring recommended in long-term therapy.

Common:

• Gastrointestinal: Flatulence, diarrhea, abdominal discomfort, bloating (due to fermentation of undigested carbohydrates).
• Mild nausea or constipation occasionally.

Serious but Rare:

• Intestinal obstruction (in predisposed patients).
• Allergic reactions (rash, itching, angioedema).
• Hepatic dysfunction (rare reports).

Timing & Dose Dependence:

• GI side effects typically begin within first few weeks and tend to decrease over time or with dose adjustment.

• May increase hypoglycemic effects when combined with insulin or sulfonylureas; monitor blood glucose closely.
• No significant CYP450 enzyme involvement; low potential for metabolic drug interactions.
• Concurrent use with digestive enzyme supplements may reduce efficacy.
• No major food or alcohol interactions documented, but adherence to diabetic diet recommended.

• Continued recommendation as effective postprandial glucose-lowering agent in type 2 diabetes and prediabetes by ADA and other diabetes organizations.
• No recent significant changes in dosing or safety warnings.
• Growing evidence supports early use in impaired glucose tolerance to delay diabetes onset.

• Store tablets at controlled room temperature: 20°C to 25°C (68°F to 77°F).
• Protect from moisture and light; keep in original container tightly closed.
• Avoid freezing.
• Keep out of reach of children.