Adult: As adjunct to diet and exercise to improve glycaemic control: As monotherapy or in combination with sulfonylurea: Initially, 25 mg tid at the start of each meal. Alternatively, to minimise gastrointestinal tolerance, initiate with 25 mg once daily, then gradually increase to 25 mg tid. After 4-8 weeks, titrate to a maintenance dose of 50 mg tid and continue for approx 3 months. The dose may be further increased up to a Max of 100 mg tid if the HbA1c concentration remains unsatisfactory after 3 months. Maintain therapy at the lowest effective dose, as tolerated.
Renal Impairment
CrCl (mL/min)
Dosage
<25
Not recommended.
Administration
Miglitol Should be taken with food.
Contraindications
Diabetic ketoacidosis, inflammatory bowel disease, partial intestinal obstruction or predisposition to intestinal obstruction, colonic ulceration; chronic intestinal disease associated with significant digestion or absorption disorders, or with conditions that may worsen due to increased gas formation in the intestine.
Special Precautions
Patient exposed to stress-related states (e.g. fever, infection, trauma, surgery). Not recommended in patients with severe renal impairment (CrCl <25 mL/min). Pregnancy; lactation (not recommended).
Adverse Reactions
Significant: Gastrointestinal symptoms (e.g. abdominal pain, diarrhoea); increased risk of hypoglycaemia (when given in combination with insulin or sulfonylurea). Gastrointestinal disorders: Flatulence, paralytic ileus, nausea, abdominal distention. Rarely, pneumatosis cystoides intestinalis. Investigations: Low serum iron. Skin and subcutaneous tissue disorders: Rash.
Monitor blood glucose (periodically) and HbA1c (twice a year for those who have stable glycaemic control and are meeting the treatment goals, quarterly for patients not meeting the treatment goals or with therapy changes).
Drug Interactions
May increase the hypoglycaemic effects of sulfonylurea or insulin. May reduce plasma concentration of digoxin. May significantly decrease the bioavailability of ranitidine and propranolol. Digestive enzymes preparations containing carbohydrate-splitting enzymes (e.g. amylase, pancreatin) and intestinal adsorbents (e.g. charcoal) may decrease the effect of miglitol.
Action
Description: Overview: Miglitol is an α-glucosidase inhibitor antidiabetic agent. Mechanism of Action: Miglitol reversibly inhibits membrane-bound intestinal α-glucosidases, which are enzymes that hydrolyse oligosaccharides, trisaccharides, and disaccharides into glucose and other monosaccharides at the brush border of the small intestine. Pharmacodynamics: Miglitol reduces postprandial hyperglycaemia by delaying carbohydrate digestion and glucose absorption. It does not cause hypoglycaemia when administered alone, as it does not stimulate insulin secretion. Additionally, miglitol produces an additive antihyperglycaemic effect when used with sulfonylureas and may help minimise their insulinotropic and weight-increasing effects. Pharmacokinetics: Absorption: Saturable absorption at high doses. Time to peak plasma concentration: 2-3 hours. Distribution: Enters breast milk (small amount). Volume of distribution: 0.18 L/kg. Plasma protein binding: <4%. Metabolism: Not metabolised. Excretion: Via urine (as unchanged drug). Elimination half-life: Approx 2 hours.
Chemical Structure
Miglitol Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 441314, Miglitol. https://pubchem.ncbi.nlm.nih.gov/compound/Miglitol. Accessed Oct. 27, 2025.
A10BF02 - miglitol ; Belongs to the class of alpha glucosidase inhibitors. Used in the treatment of diabetes.
References
Brayfield A, Cadart C (eds). Miglitol. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/10/2025.Glyset Tablets (Bayer HealthCare Pharmaceuticals Inc). U.S. FDA. https://www.fda.gov. Accessed 07/10/2025.Miglitol Tablet, Coated (Westminster Pharmaceuticals, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/10/2025.Miglitol. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/10/2025.Miglitol. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/10/2025.
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