Acarbose and Rasagiline: 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
Rasagiline
Acarbose
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.
Rasagiline (Azilect) is a type of medicine called an MAOI, often used for Parkinson's disease. Acarbose (Precose) is a diabetes medicine that helps lower your blood sugar. When these are taken together, your blood sugar may drop lower than expected. That can cause hypoglycemia, with symptoms like shakiness, sweating, dizziness, confusion, or feeling very hungry.
The good news is that this is very manageable. Your care team can keep a closer eye on your blood sugar readings and adjust your diabetes medicine if needed. Please don't stop either drug on your own. Just check in with your pharmacist or doctor so they can guide you.
Effect: Additive glucose-lowering, increasing hypoglycemia risk when rasagiline (an MAO-B inhibitor) is combined with acarbose.
Mechanism: Not fully established; MAOIs may promote hyperinsulinemia in type 2 diabetics with retained insulin secretory capacity, potentiating hypoglycemic response. Neither agent is a prodrug relevant here.
Onset: Rapid. Evidence: Probable. Severity: Moderate.
- Monitor blood glucose closely, especially when rasagiline is started or stopped.
- Doses of acarbose (or other hypoglycemics) may need individualized reduction.
- Discontinuation of one agent may be warranted if hypoglycemia is significant.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Concurrent administration of certain MAOIs may enhance the blood glucose reducing action of hypoglycemic medications 23. In individuals with type 2 diabetes who retain the ability to secrete insulin, MAOIs can produce hyperinsulinemia 7. When an MAOI is initiated or withdrawn in a patient already taking a hypoglycemic agent, blood glucose should be monitored closely. It may be necessary to reduce the doses of insulin or oral hypoglycemic agents 12, or alternatively to discontinue one of the two interacting drugs 4.
Why it happens (mechanism)
Unknown
How to manage this interaction
You can usually take both safely with a little extra attention from your care team.
- Watch your blood sugar more closely, particularly when rasagiline is first added or later stopped.
- Learn the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat quickly if they occur.
- Your diabetes medicine dose may need to be adjusted and individualized by your team.
Keep taking both medicines exactly as prescribed unless your doctor or pharmacist tells you otherwise. If you notice frequent low readings or symptoms, contact them so they can fine-tune your plan.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) MAOI agents can potentiate the blood glucose lowering action of hypoglycemic medications. The suggested mechanism was that MAOI drugs interfere with the homeostatic adrenergic response to hypoglycemia 5, although this mechanism has not been confirmed 6. MAOIs seem to produce hyperinsulinemia 7.
b) Administration of selegiline (a selective MAO-B inhibitor) resulted in marked hypoglycemia in a 70-year old man who had Parkinson's disease. This hypoglycemia was associated with hyperinsulinemia and continued for one week after selegiline was stopped 8.
Common questions
Can I take Acarbose and Rasagiline together?
Combining rasagiline with acarbose can increase the risk of low blood sugar, so monitor your glucose more closely and let your care team adjust your diabetes medicine if needed. Do not stop either drug on your own. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Rasagiline interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How is the Acarbose and Rasagiline interaction managed?
You can usually take both safely with a little extra attention from your care team. Watch your blood sugar more closely, particularly when rasagiline is first added or later stopped. Learn the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat quickly if they occur. Your diabetes medicine dose may need to be adjusted and individualized by your team. Keep taking both med… 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 Rasagiline 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 (8)
- 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: Starlix(R) oral tablets, nateglinide oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2011. DailyMed
- Product Information: ZYVOX(R) intravenous injection, oral tablets suspension, linezolid intravenous injection, oral tablets suspension. Pfizer Inc. (per FDA), New York, NY, 2013. DailyMed
- Cooper AJ & Ashcroft G: Modification of insulin and sulfonylurea hypoglycemia by monoamine-oxidase inhibitor drugs. Diabetes 1967; 16:272-274. PubMed
- Adnitt PI: Hypoglycemic action of monoamineoxidase inhibitors (MAOI'S). Diabetes 1968; 17:628-633. PubMed
- Bressler R, Vargas-Cord M, & Lebovitz HE: Tranylcypromine: a potent insulin secretagogue and hypoglycemic agent. Diabetes 1968; 17:617-624. PubMed
- Rowland MJ, Bransome ED Jr. & Hendry LB: Hypoglycemia caused by selegiline, an antiparkinsonian drug: can such side effects be predicted?. J Clin Pharmacol 1994; 34:80-85. DOI
Keep reading about Rasagiline
Keep reading about Acarbose
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