Acarbose and Levobunolol: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 10, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Acarbose
Levobunolol
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Acarbose helps lower your blood sugar, and levobunolol is a beta-blocker. Even though levobunolol comes as eye drops for glaucoma, enough can reach your bloodstream to matter. When these two are used together, your blood sugar can swing either lower or higher, and (this is the big point) the beta-blocker can hide some of the usual warning signs of low blood sugar, like a racing heartbeat. You may still notice sweating or dizziness, but the pounding-heart signal can be muffled.
The good news: this is very manageable. Your care team can check your sugar more often and adjust things as needed. Keep taking both as prescribed and let your pharmacist or doctor know how you feel.
Effect: Beta-blockade (even from ophthalmic levobunolol, which is nonselective and can be systemically absorbed) may alter glycemic control with acarbose, producing hypo- or hyperglycemia and blunting adrenergic warning signs of hypoglycemia (notably tachycardia; sweating and dizziness are often preserved).
- Mechanism: altered glucose metabolism plus beta-blockade; nonselective agents can potentiate and prolong hypoglycemia recovery.
- Direction: variable; neither drug is a prodrug.
- Onset: delayed. Evidence: probable.
- Management: increase glucose monitoring frequency; individualize antidiabetic dosing; watch for masked hypoglycemia; on beta-blocker withdrawal, monitor for loss of glycemic control.
What happens
Hypoglycemia or hyperglycemia; decreased symptoms of hypoglycemia
Interaction Deep Dive
When antidiabetic medications are taken together with beta-blockers, the result may be either hypoglycemia or hyperglycemia, and the combination can also mask the warning signs of hypoglycemia12. Among those signs, tachycardia may be blunted, whereas others such as dizziness and sweating are not affected6. Insulin-induced hypoglycemia can be intensified by nonselective beta blockers, which may also hinder the return of serum glucose to normal levels. In individuals who have both heart failure and diabetes, hyperglycemia may become worse7. It may be necessary to check glucose more often or to modify the dose of the antidiabetic drug12. During combined use, watch carefully for hypoglycemia signs and symptoms, and should the beta-blocker be discontinued, monitor for a loss of glycemic control3.
Why it happens (mechanism)
Altered glucose metabolism and beta blockade
How to manage this interaction
This interaction is very manageable with a few practical steps.
- Keep taking both acarbose and levobunolol exactly as prescribed unless your care team tells you otherwise.
- Check your blood sugar more often, especially when starting or stopping the eye drops, so your team can spot swings early.
- Your acarbose dose may need to be adjusted and individualized by your care team based on your readings.
- Know that a racing heartbeat may not warn you of low sugar, so watch for sweating, dizziness, or shakiness.
Tell your pharmacist or doctor if you have low or high sugar readings, or if the eye drops are stopped.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In elderly diabetic patients receiving either insulin or sulfonylureas, the selection of antihypertensive agent had minimal effect on hypoglycemia risk; however, once other risk factors were accounted for, the lowest risk occurred with cardioselective beta blockers and the highest with non-cardioselective beta blockers, while other antihypertensive medications fell in between (N=13,559) 4.
b) Beta blockers, though not alpha blockade or ACE inhibitors, produced a worsening of long-term glycemic control in patients with hypertension and non-insulin dependent diabetes. Certain unfavorable changes in the lipid profile also arose with beta blockade. These effects were particularly evident with propranolol. Using an alpha blocker together with the beta blocker prevented the worsening caused by beta blockade 5.
Common questions
Can I take Acarbose and Levobunolol together?
Levobunolol can mask the racing-heartbeat warning of low blood sugar and shift your glucose control, so monitor your sugar more closely and keep both drugs as prescribed while your care team fine-tunes your acarbose dose. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Levobunolol interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How is the Acarbose and Levobunolol interaction managed?
This interaction is very manageable with a few practical steps. Keep taking both acarbose and levobunolol exactly as prescribed unless your care team tells you otherwise. Check your blood sugar more often, especially when starting or stopping the eye drops, so your team can spot swings early. Your acarbose dose may need to be adjusted and individualized by your care team based on your readings. Kn… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Acarbose or Levobunolol need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (7)
- Product Information: TOUJEO(R) subcutaneous injection, insulin glargine subcutaneous injection. sanofi-aventis (per manufacturer), Bridgewater, NJ, 2015. DailyMed
- Product Information: AMARYL(R) oral tablets, glimepiride oral tablets. Sanofi-Aventis U.S. LLC (per FDA), Bridgewater, NJ, 2013. DailyMed
- Product Information: Glynase(R) PresTab(R) oral micronized tablets, glyburide oral micronized tablets. Pharmacia & Upjohn Co (per FDA), New York, NY, 2013. DailyMed
- Shorr RI, Ray WA, Daugherty JR, et al: Antihypertensives and the risk of serious hypoglycemia in older persons using insulin or sulfonylureas. JAMA 1997; 278:40-43. DOI
- Whitcroft IA, Thomas JM, Rawsthorne A, et al: Effects of alpha and beta adrenoceptor blocking drugs and ACE inhibitors on long term glucose and lipid control in hypertensive non-insulin dependent diabetics. Horm Metab Res Suppl 1990; 22:42-46.
- Product Information: TENORMIN(R) oral tablets, atenolol oral tablets. AstraZeneca Pharmaceuticals LP (per FDA), Wilmington, DE, 2012. DailyMed
- Product Information: COREG CR(R) extended-release oral capsules, carvedilol phosphate extended-release oral capsules. GlaxoSmithKline, Research Triangle Park, NC, 2011. DailyMed
Keep reading about Acarbose
Keep reading about Levobunolol
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