Acarbose and Tranylcypromine: 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
Tranylcypromine
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.
You've been prescribed tranylcypromine (Parnate), an antidepressant in the MAOI family, along with acarbose (Precose), which helps lower your blood sugar. When these are taken together, the MAOI can make the blood-sugar-lowering effect stronger, so your sugar may drop lower than expected.
Watch for signs of low blood sugar like shakiness, sweating, dizziness, confusion, or a fast heartbeat. This is very manageable. Your care team can check your blood sugar more closely and adjust your doses if needed, especially when the MAOI is first started or later stopped. Don't change anything on your own, just talk with your pharmacist or doctor.
Effect: Additive glucose lowering, increased hypoglycemia risk when tranylcypromine (MAOI) is combined with acarbose.
Mechanism: Not fully established; MAOIs may produce hyperinsulinemia in type 2 patients with retained insulin secretory capacity, augmenting the hypoglycemic response. Neither agent is a prodrug requiring activation.
- Onset: rapid
- Evidence: probable
- Severity: moderate
Management: Monitor blood glucose closely, particularly when the MAOI is initiated or discontinued. Doses of acarbose (or other hypoglycemics/insulin) may need individualized downward adjustment; in some cases discontinuation of one agent may be warranted.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
When certain MAOIs are taken alongside hypoglycemic agents, the blood glucose lowering action of those agents can be enhanced23. In individuals with type 2 diabetes who still retain the ability to secrete insulin, MAOIs may produce hyperinsulinemia7. Whenever an MAOI is either started or stopped in a patient already taking a hypoglycemic agent, blood glucose should be monitored closely. It may become necessary to reduce the dose of insulin or of oral hypoglycemic agents12, or alternatively to stop one of the interacting drugs4.
Why it happens (mechanism)
Unknown
How to manage this interaction
Keep taking both medications as prescribed unless your care team tells you otherwise. This interaction is manageable with attention and monitoring.
- Your team may check your blood sugar more closely, especially right after the MAOI is started or when it is stopped.
- Your diabetes medication dose may need to be adjusted and individualized by your care team to prevent lows.
- Learn the signs of low blood sugar (shakiness, sweating, confusion) and know how to treat a low.
- Raise this combination with your pharmacist or prescriber so they can plan monitoring and any dose changes.
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 involved MAOI agents interfering with the homeostatic adrenergic response to hypoglycemia 5; however, this mechanism was not confirmed 6. MAOIs seem to produce hyperinsulinemia 7.
b) Administration of 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 following discontinuation of selegiline 8.
Common questions
Can I take Acarbose and Tranylcypromine together?
Combining tranylcypromine with acarbose can lower your blood sugar more than expected, so your team may monitor your glucose closely and adjust your diabetes dose, especially when the MAOI is started or stopped. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Acarbose and Tranylcypromine 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 Tranylcypromine interaction managed?
Keep taking both medications as prescribed unless your care team tells you otherwise. This interaction is manageable with attention and monitoring. Your team may check your blood sugar more closely, especially right after the MAOI is started or when it is stopped. Your diabetes medication dose may need to be adjusted and individualized by your care team to prevent lows. Learn the signs of low bloo… 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 Tranylcypromine 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 Tranylcypromine
Keep reading about Acarbose
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist