© Diabetes patients may take a large number of medications to manage blood glucose, cholesterol, blood pressure, etc. which may increase the probability of Drug interactions.
© Most of the clinically important drug-drug interactions of anti-diabetic agents are related to their metabolic pathways.
© Gemfibrozil inhibits CYP2C8 mediated metabolism of Repaglinide and increases its plasma concentrations. It is contraindicated to use Repaglinide and Gemfibrozil together due to potential interaction which may proceed to hypoglycemic complications.
© The risk of Lactic acidosis and acute renal failure is increased by the concomitant use of Metformin and Injection of iodinated contrast materials (Iocetamic acid, Iopronic acid, Ioxitalamic acid, Iodoxamic acid, Acetrizoic acid, Metrizoic acid, Ioglycemic acid, Iopanoic acid, Iodohippuric acid, Ioseric acid, Iobenzamic acid, Ioglycic acid, Iocarmic acid, Iotroxic acid, Iobitridol, Iodamide, Ipodate, Iodixanol, Iodopyralet, Iosimide, Ethiodized oil, Metrizamide, Tyroponate sodium, Iopentol, Iodipamide, Iotasul, Iotrolan, Ioxaglate, Diatrizoate, Iothalamate, Iohexol, Iopromide, Iopamidol, Iophendylate, Ioversol and Iomeprol). Concurrent use of metformin is contraindicated in patients receiving intravascular iodinated contrast media.
© Carbonic anhydrase inhibitors (Topiramate, Acetazolamide, Zonisamide and Dichlorphenamide) may decrease sodium bicarbonate levels and increase the risk of metabolic acidosis while administered along with Metformin. Concomitant use of metformin and topiramate is contraindicated.
© Metformin is a cationic (positively charged) molecule and may compete for organic cation transporters in the kidneys with other cationic drugs (Cimetidine, Ranitidine, Procainamide, Digoxin, Quinidine, Quinine, Morphine, Triamterene, Amiloride, Dolutegravir, Cephalexin, Trimethoprim, and vancomycin) for renal secretion which leads to the inhibition of renal organic cation transporters. The risk of metformin-associated lactic acidosis (MALA) is elevated due to the inhibition of renal organic cation transporters and increased metformin plasma concentrations.
© The diabetics should be warned that excessive hypoglycaemia may occur due to the inhibition of CYP2C9 mediated metabolism of sulfonylureas by Azole Antifungals (Fluconazole, Itraconazole, Ketoconazole, Miconazole, Variconazole), Fibrates (Gemfibrozil, Clofibrate, Bezafibrate, Ciprofibrate and Fenofibrate), Sulfonamides (Sulfaphenazole, sulfadiazine, sulfamethizole, sulfafurazole (sulfisoxazole), sulfamethoxazole, sulfapyridine, sulfadimethoxine and sulfamonomethoxine and Macrolide Antibiotics (Erythromycin, Clarithromycin).
© The metabolism of thiazolidinediones is inhibited by CYP2C8 inhibitors like Abiraterone, Pixantrone, Azole Antifungals (Fluconazole, Ketoconazole, Itraconazole, Miconazole), Fibrates (Gemfibrozil, Fenofibrate) and Teriflunomide which may result into increased risk of hypoglycemia.
© Acarbose may decrease the therapeutic efficacy of Digoxin by reducing its absorption.
© Acarbose may increase the risk of bleeding by increasing the absorption of Warfarin.
© Concomitant use of DPP4 inhibitors and P-glycoprotein inhibitors such as Tocofersolan, Nilotinib and Lomitapide may result into increased plasma levels of DPP4 inhibitors due to the inhibition of P-glycoprotein-mediated efflux transport of DPP4 inhibitors.
© The diabetics should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements (Herbs, Vitamins, Minerals, etc.), during their visit to the doctor or pharmacist.
© The risk of adverse effects could be reduced and the quality of life for diabetics improved by healthcare professionals through the screening, education, and follow up on suspected drug interactions.
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