Safinamide and Acarbose: 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
Safinamide
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.
Safinamide (Xadago) is a medicine for Parkinson's disease, and it acts as a type of MAOI. Acarbose (Precose) helps lower blood sugar in type 2 diabetes. When taken together, safinamide can make acarbose's blood sugar lowering effect a little stronger, so your blood sugar may drop too low. Signs of low blood sugar include feeling shaky, sweaty, dizzy, confused, or very hungry.
The good news is this is very manageable. Your care team can watch your blood sugar more closely and adjust your doses if needed. Keep taking both medicines as prescribed, and talk with your pharmacist or doctor about the best plan for you.
Effect: Additive risk of hypoglycemia when safinamide (an MAO-B inhibitor with some MAOI-class activity) is combined with acarbose.
Mechanism: Unknown; MAOIs may promote hyperinsulinemia in type 2 patients retaining insulin secretory capacity, augmenting the glucose-lowering effect. Neither agent is a prodrug relevant here.
- Direction: Increased hypoglycemic effect
- Onset: Rapid
- Evidence: Probable, severity moderate
- Management: Closely monitor blood glucose when safinamide is started or stopped. Antidiabetic dose may need to be adjusted and individualized; occasionally discontinuation of one agent is required.
What happens
An increased risk of hypoglycemia
Interaction Deep Dive
Certain MAOIs taken alongside hypoglycemic drugs may enhance the blood glucose lowering action of those agents 23. In individuals with type 2 diabetes who still retain the ability to secrete insulin, MAOIs can produce hyperinsulinemia 7. Whenever an MAOI is started or stopped in a patient already taking a hypoglycemic agent, blood glucose should be monitored closely. It may be necessary to reduce the dose of insulin or oral hypoglycemic agents 12, or to discontinue one of the interacting drugs 4.
Why it happens (mechanism)
Unknown
How to manage this interaction
This interaction is manageable with attention from your care team.
- Keep taking both medicines as prescribed unless your doctor tells you otherwise.
- Check your blood sugar more closely, especially right after safinamide is started or stopped, since changes can happen quickly.
- Your acarbose dose may need to be adjusted and individualized by your team if your sugars run low.
- Learn the signs of low blood sugar (shaky, sweaty, dizzy, confused) and how to treat them.
Ask your pharmacist or prescriber how to monitor and what to do if your readings drop.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) Drugs classified as MAOIs may potentiate the blood glucose lowering action of hypoglycemic agents. The suggested mechanism involved interference by MAOI drugs with the homeostatic adrenergic response to hypoglycemia 5, although this mechanism was not verified 6. MAOIs seem to induce hyperinsulinemia 7.
b) Administration of selegiline (a selective MAO-B inhibitor) resulted in 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 the discontinuation of selegiline 8.
Common questions
Can I take Safinamide and Acarbose together?
Combining safinamide with acarbose can increase the chance of low blood sugar, so monitor your levels closely (especially when safinamide is started or stopped) and let your care team adjust your dose if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Safinamide and Acarbose 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 Safinamide and Acarbose interaction managed?
This interaction is manageable with attention from your care team. Keep taking both medicines as prescribed unless your doctor tells you otherwise. Check your blood sugar more closely, especially right after safinamide is started or stopped, since changes can happen quickly. Your acarbose dose may need to be adjusted and individualized by your team if your sugars run low. Learn the signs of low bl… 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 Safinamide or Acarbose 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 Safinamide
Keep reading about Acarbose
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