Drug Interactions of Thiazolidinediones (TZDs)

     https://www.ajpbp.com/?mno=12698

https://www.researchgate.net/publication/329336851_Thiazolidinediones_and_their_drug_interactions_involving_CYP_enzymes

https://www.ejmanager.com/mnstemps/61/61-1539504628.pdf?t=1543816308

   

   ·       Thiazolidinediones (TZDs) include Pioglitazone and Rosiglitazone and they are indicated in the treatment of type 2 diabetes mellitus.

   ·       TZDs are insulin sensitizers and are metabolized primarily by the CYP2C8 enzyme.

   ·         TZDs bind to peroxisome proliferator-activated receptors gamma (PPARγ) of adipose tissue, liver, and skeletal muscle cells and induce the glucoregulatory molecules to enhance the insulin sensitivity.

   ·       The drugs inhibiting or inducing CYP2C8 enzyme may result in pharmacokinetic drug interactions of TZDs.

   ·       Drugs increasing the risk of Concentration-dependent adverse effects of TZDs

Ø Gemfibrozil

Ø Clopidogrel

Ø Ketoconazole

Ø Trimethoprim

   ·       Drugs decreasing Therapeutic efficacy of TZDs

Ø Rifampicin

   ·       Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

   ·       The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   ·        The diabetic patients should bring a list of all of the drugs they are taking (or simply bring the drugs themselves), including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

   ·       They are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

   ·        It is recommended that people fill all their prescriptions at one pharmacy, if possible.

https://www.ajpbp.com/?mno=12698

https://www.ejmanager.com/mnstemps/61/61-1539504628.pdf?t=1543816308

Drug Interactions of Sulfonylurea Antidiabetics

https://www.researchgate.net/publication/327860217_Pharmacokinetic_and_Pharmacodynamic_Interactions_of_Sulfonylurea_Antidiabetics

http://ejournal5.com/journals_n/1536671299.pdf

   §    Sulfonylurea (SUs) antidiabetics include first-generation drugs such as Tolbutamide, Chlorpropamide, etc and second-generation drugs like gliclazide, glipizide, glibenclamide, etc.

   §     They are insulin secretogogues, which induce the release of insulin from beta cells of pancreas and decrease the blood sugar levels.

   §    Absorption interactions

Ø Magnesium salts containing antacids (Increase the absorption of SUs)

Ø Bile acid sequestrants (Decrease the absorption of SUs)

   §    Metabolism Interactions

Ø Drugs decreasing Therapeutic efficacy of SUs

·      Rifampicin

·      St John's Wort (Hypericum perforatum)

Ø Drugs increasing the risk of Hypoglycemia

·      Fibrates (Gemfibrozil, Fenofibrate)

·      Sulfonamides (Sulfaphenazole, Sulfadiazine, Sulfamethizole, Sulfisoxazole, Sulfaphenazole, and Sulfamethoxazole)

·      Azole antifungals (Voriconazole, Miconazole, Ketoconazole, Fluconazole, etc.)

·      Isoniazid

·      Metronidazole

·      Cimetidine

·      Fluvoxamine

   §    Pharmacodynamic Interactions of SUs

Ø ACE Inhibitors

Ø Beta-adrenergic blockers

Ø Disopyramide

Ø Aspirin

Ø Phenylbutazone

Ø Fluoroquinolones

   §    Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

   §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   §    The diabetic patients should bring a list of all of the drugs they are taking (or simply bring the drugs themselves), including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

   §    They are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

   §    It is recommended that people fill all their prescriptions at one pharmacy, if possible.

http://ejournal5.com/journals_n/1536671299.pdf

Drug Interactions of Sulfonylurea Antidiabetics with Common Herbs:

https://www.researchgate.net/publication/326145863_Pharmacologically_relevant_drug_interactions_of_sulfonylurea_antidiabetics_with_common_herbs


http://www.herbmedpharmacol.com/Abstract/jhp-1280

  §    Sulfonylurea (SUs) antidiabetics include first-generation drugs such as Tolbutamide, Chlorpropamide, etc and second-generation drugs like gliclazide, glipizide, glibenclamide, etc.

  §     They are insulin secretogogues, which induce the release of insulin from beta cells of pancreas and decrease the blood sugar levels.

  §    Herbs decreasing the therapeutic efficacy of SUs

Ø St John’s Wort (Hypericum perforatum)

Ø Ginkgo biloba

  §    Fruit Juices increasing the exposure of SUs

Ø Pomegranate (Punica granatum) juice

Ø Pineapple juice

  §    Herbs potentiating hypoglycemic activity of SUs

Ø Bitter melon or bitter gourd (Momordica charantia)

Ø Fenugreek (Trigonella foenum-graceum)

Ø Cinnamon

Ø Gymnema (Gymnema sylvestre)

Ø Ginseng

Ø Ginger (Zingiber officinale)

Ø Garlic (Allium sativum)

Ø Aloe vera (Aloe barbadensis Miller)

Ø Sesame (Sesamum indicum) oil

Ø Andrographis paniculata

Ø Neem (Azadirachta indica)

  §    Healthcare professionals through the screening, education, and follow up on suspected drug interactions could reduce the risk of adverse effects.

  §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

  §    The diabetic patients should bring a list of all of the drugs they are taking (or simply bring the drugs themselves), including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

  §    They are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

  §    It is recommended that people fill all their prescriptions at one pharmacy, if possible.

http://www.herbmedpharmacol.com/Abstract/jhp-1280

Drug Interactions of Meglitinide Antidiabetics (Repaglinide & Nateglinide):

http://journals.sagepub.com/doi/abs/10.1177/2042018818767220

https://www.researchgate.net/publication/324261559_Drug_interactions_of_meglitinide_antidiabetics_involving_CYP_enzymes_and_OATP1B1_transporter

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6116761/

   §    Meglitinides including Repaglinide and Nateglinide are short acting insulin secretogogues.

   §    They are very much useful to treat the patients with Type 2 Diabetes Mellitus having irregular meal timings.

   §    Interaction between one or more coadministered medications leading to reduced therapeutic efficacy or enhanced toxicity is termed as “Adverse drug interaction”.

   §   Mechanism of action of Meglitinide Antidiabetics:

   §    Most of the drug interactions of Metformin result in enhanced risk of “Hypoglycemia”.

   §    Concurrent use of the following drugs along with Repaglinide, elevate its plasma concentrations and the risk of Hypoglycemia…

ª    Gemfibrozil

ª    Clopidogrel

ª    Cyclosporine

ª    Trimethoprim

ª    Atorvastatin

ª    Nifedipine

   §    Drugs interacting with Nateglinide include…

ª    Azole Antifungals

ª    Rifampicin

   §    The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

   §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   §    The diabetic patients should bring a list of all of the drugs they are taking (or simply bring the drugs themselves), including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

   §    They are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

   §    It is recommended that people fill all their prescriptions at one pharmacy, if possible.

http://journals.sagepub.com/doi/abs/10.1177/2042018818767220

Drug Interactions of Metformin:

       

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788205/

https://www.researchgate.net/publication/322913924_Drug_Interactions_of_Metformin_Involving_Drug_Transporter_Proteins

More Presentations from Naina Mohamed, PhD

   §    Metformin is usually a first-line drug to treat Type 2 diabetes mellitus.

   §    Metformin is also found to be useful to treat various conditions include…

ª    Prediabetes

ª    Gestational diabetes mellitus (GDM)

ª    Polycystic Ovarian Syndrome (PCOS)

ª    Obesity

ª    Cancer, etc.

   §    Interaction between one or more coadministered medications leading to reduced therapeutic efficacy or enhanced toxicity is termed as “Adverse drug interaction”.

   §   Mechanism of action of Metformin: 

   §    Most of the drug interactions of Metformin result in enhanced risk of “Metformin Associated Lactic Acidosis (MALA)”.

   §    The symptoms of MALA include…

ª    Nausea

ª    Vomiting

ª    Fatigue

ª    Lethargy

ª    Confusion

ª    Abdominal pain

ª    Thirst

   §    Concurrent use of the following drugs along with Metformin, elevate its plasma concentrations and the risk of MALA…

ª    Iodinated Contrast Materials (ICMs)

ª    H₂ receptor blockers (Cimetidine, Ranitidine)

ª    Proton pump inhibitors

ª    Antimicrobials (Trimethoprim, Cephalexin, Rifampin, Dolutegravir)

ª    Ranolazine

ª    Anticancer Drugs (Vandetanib, Imatinib, Nilotinib, Gefitinib, and Erlotinib)

ª    Beta adrenergic blockers (Atenolol, Metoprolol)

   §    The risk of adverse effects could be reduced by healthcare professionals through the screening, education, and follow up on suspected drug interactions.

   §    The diabetic patients should always consult their physician and pharmacist before taking any new medication.

   §    The diabetic patients should bring a list of all of the drugs they are taking (or simply bring the drugs themselves), including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

   §    They are encouraged to ask their doctor or pharmacist to look over their list for any potentially dangerous combinations.

   §    It is recommended that people fill all their prescriptions at one pharmacy, if possible.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5788205/