Acarbose and Selegiline: 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
Selegiline
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.
Selegiline (Anipryl, Zelapar) is a type of medicine called an MAOI. Acarbose (Precose) is a diabetes pill that helps lower your blood sugar. When these are taken together, your blood sugar may drop lower than expected. That means you could be more likely to have a low blood sugar episode, with symptoms like shakiness, sweating, dizziness, or feeling confused.
The good news is this is very manageable. Keep taking both medicines exactly as prescribed, and let your care team know you are on both. They can watch your blood sugar more closely and adjust your diabetes dose if needed so you stay in a safe range.
Effect: MAOIs such as selegiline may enhance the glucose-lowering effect of hypoglycemic agents like acarbose, increasing hypoglycemia risk.
- Mechanism: Not fully established; MAOIs may promote hyperinsulinemia in type 2 patients with retained insulin secretory capacity. This is a pharmacodynamic interaction (neither agent is affected by prodrug activation here).
- Direction: Additive/enhanced hypoglycemic effect.
- Onset: Rapid. Evidence: Probable. Severity: Moderate.
- Management: Closely monitor blood glucose when selegiline is initiated or discontinued. Lower doses of the hypoglycemic agent may be required; occasionally discontinuation of one agent is warranted.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
When certain MAOIs are taken together with hypoglycemic agents, the glucose lowering action of those agents can be enhanced 23. In patients with type 2 diabetes who still retain the ability to secrete insulin, MAOIs may produce hyperinsulinemia 7. Whenever an MAOI is either initiated or withdrawn in a patient who is taking a hypoglycemic agent, blood glucose levels should be monitored closely. It may be necessary to reduce the dose of insulin or oral hypoglycemic agents 12, or alternatively to stop one of the interacting medications 4.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction is manageable with monitoring and dose tailoring by your care team.
- Keep taking both medicines as prescribed unless your prescriber tells you otherwise.
- Your team may check your blood sugar more closely, especially when selegiline is started or stopped.
- Your diabetes medication dose may need to be adjusted and individualized to keep you in a safe range.
- Know the signs of low blood sugar (shakiness, sweating, dizziness, confusion) and treat them promptly.
- Tell your pharmacist or doctor about any low blood sugar episodes 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 intensify the blood glucose lowering action of hypoglycemic medications. The suggested mechanism was that MAOI agents interfere with the homeostatic adrenergic response to hypoglycemia 5, although this mechanism was not verified 6. MAOIs seem to produce hyperinsulinemia 7.
b) Therapy with selegiline (a selective MAO-B inhibitor) caused severe 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 Selegiline together?
Taking selegiline with acarbose can increase the chance of low blood sugar, so keep both as prescribed but monitor your blood sugar closely, especially when selegiline is started or stopped, and report any lows to your care team. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Selegiline 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 Selegiline interaction managed?
This interaction is manageable with monitoring and dose tailoring by your care team. Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Your team may check your blood sugar more closely, especially when selegiline is started or stopped. Your diabetes medication dose may need to be adjusted and individualized to keep you in a safe range. Know the signs of low blood… 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 Selegiline 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 Selegiline
Keep reading about Acarbose
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