Antidiabetic Drug Interactions

• Drug interactions of antidiabetic drugs

Antidiabetics + ACE Inhibitors

• ACE inhibitors are considered beneficial for individuals with diabetes
• Hypoglycemia can occur when combining insulin or sulfonylureas with ACE inhibitors like captopril, enalapril, lisinopril, or perindopril
• It is advisable to warn patients starting ACE inhibitors while on insulin or oral antidiabetics about the risk of unpredictable hypoglycemia
• To mitigate any issues, increase the frequency of blood glucose monitoring
• Problems can typically be resolved by reducing the sulfonylurea dose
• Sitagliptin may alter the hypotensive effects of enalapril

Antidiabetics + Alcohol

• Diabetics on insulin, oral antidiabetics, or diet management do not necessarily need to avoid alcohol, but should consume it in moderation with food
• Alcohol can mask the signs of hypoglycemia and cause delayed hypoglycemia
• Combining the CNS depressant effects of alcohol with hypoglycemia can significantly increase the risk associated with driving or operating dangerous machinery

Antidiabetics + Allopurinol

• Allopurinol can negatively impact glycemic control in type 2 diabetics receiving insulin
• Marked hypoglycemia and coma were reported in one patient taking gliclazide and allopurinol
• Allopurinol increases the half-life of chlorpropamide and slightly decreases the half-life of tolbutamide

Antidiabetics + Antidiabetics (Pioglitazone and Rosiglitazone)

• Pioglitazone and rosiglitazone can cause fluid retention and peripheral edema, worsening or causing heart failure
• There is a higher incidence of these effects when pioglitazone or rosiglitazone are used with insulin, sulfonylureas, or saxagliptin
• Rosiglitazone used with insulin may increase the risk of myocardial ischaemia
• Concurrent use may also increase the incidence of hypoglycemia

Antidiabetics + Antihistamines

• The combination of biguanides (e.g., metformin) and ketotifen is generally well-tolerated, but one study reported a decrease in platelet count
• Manufacturers contraindicate their concurrent use until the effect is further understood

Antidiabetics + Antimalarials

• Hydroxychloroquine can lower insulin requirements, leading to hypoglycemia in diabetics managed with insulin
• Hydroxychloroquine has also improved glycemic control in patients taking glipalamide (glyburide)
• Hypoglycemia was reported in a patient on chloroquine and insulin; quinine reduces blood glucose levels in patients taking gliclazide

Antidiabetics + Antipsychotics

• Chlorpromazine can increase blood glucose concentrations, especially at daily doses of 100 mg or more, while smaller doses of 50 to 70 mg daily do not typically cause hyperglycemia
• Other classical antipsychotics can affect diabetic control, with haloperidol being one example
• Atypical antipsychotics like clozapine, olanzapine, and risperidone are linked to an increased risk of glucose intolerance

Antidiabetics + Aspirin

• Analgesic doses of aspirin and other salicylates can lower blood glucose levels, but small analgesic doses usually do not adversely affect patients on antidiabetics
• Large doses of salicylates may have a more significant effect
• Increase monitoring of blood glucose levels during the initial use of large doses of aspirin or salicylates, and adjust the antidiabetic dose accordingly
• Small antiplatelet doses of aspirin are unlikely to cause a problem

Antidiabetics + Beta Blockers

• In diabetics using insulin, propranolol may impair the normal increase in blood glucose in response to hypoglycemia
• Serious and severe hypoglycemia is rare
• Be aware that beta blockers can mask some typical warning signs of hypoglycemia; warn all patients
• Monitor the effects of concurrent use carefully, avoid non-selective beta blockers if possible, and check for any evidence that the antidiabetic dose needs adjustment

Antidiabetics + Calcium-Channel Blockers

• Diltiazem and Verapamil moderately increase exposure to saxagliptin
• Calcium-channel blockers affect insulin secretion and glucose regulation, but significant disturbances in diabetes control are rare
• Monitor blood glucose concentrations more closely on concurrent use, and reduce the dose of saxagliptin if necessary

Antidiabetics + Contraceptives

• Some women may need slight antidiabetic dose adjustments while taking hormonal contraceptives
• Routine monitoring ought to be sufficient to detect any interactions, as the effects appear gradual
• Hormonal contraceptives should be used cautiously in diabetic patients due to the increased risk of arterial disease, irrespective of diabetic control
• The lowest-strength combined oral contraceptive preparations (20 micrograms of oestrogen) may minimize adverse effects on diabetic control

Antidiabetics + Corticosteroids

• Corticosteroids with glucocorticoid (hyperglycaemic) activity counteract the blood glucose-lowering effects of antidiabetics
• Significant hyperglycaemia has been observed with systemic corticosteroids, high-dose inhaled corticosteroids, or high-potency topical corticosteroids
• Increase blood glucose monitoring when starting corticosteroid treatment and adjust the antidiabetic treatment accordingly

Antidiabetics + Diuretics

• Loop diuretics(ethacrynic acid, furosemide, or torasemide) do not usually significantly disturb diabetes control, but ethacrynic acid and furosemide can sometimes elevate blood glucose levels; no action needed
• Thiazide and related diuretics can reduce the effects of antidiabetics and impair diabetes control by raising blood glucose levels, but this effect is dose-related and less frequent at low doses

Antidiabetics + Co-trimoxazole

• Acute hypoglycemia has occasionally and unpredictably occurred in patients given various sulfonylureas and co-trimoxazole

Antidiabetics + Quinolones

• Severe hypoglycemia has occurred in diabetic patients taking gatifloxacin with various antidiabetics, including sulfonylureas, insulin, metformin, pioglitazone, repaglinide, and rosiglitazone