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/

Drug Interactions of Antiplatelets (Part 6):

Drug Interactions of Vorapaxar:

More Presentations from Naina Mohamed, PhD

©   Vorapaxar is an antiplatelet drug and it is the antagonist of Protease activated receptor-1 (PAR-1) (Thrombin Receptor).

©   Vorapaxar is useful in the secondary prevention of atherothrombotic events occurring in patients with a history of myocardial infarction or peripheral arterial disease.

©   Mechanism of action of Vorapaxar:

©   Vorapaxar is a substrate of CYP3A4 enzyme and its exposure is expected to be elevated by CYP3A4 inhibitors such as…

Ø Ketoconazole

Ø Itraconazole

Ø Posaconazole

Ø Clarithromycin

Ø Nefazodone

Ø Ritonavir

©    CYP3A4 inducers decrease Vorapaxar exposure which include…

Ø Rifampin

©   Drug interactions can result in significant morbidity and mortality and thus minimizing the risk for drug interactions should be a goal in drug therapy.

©   The patients on antiplatelet therapy should bring a list of all of the drugs they are taking including prescription drugs, over-the-counter drugs, and any supplements, herbal or otherwise, during their visit to the doctor or pharmacist.

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

©   If possible, the patients are recommended to fill all their prescriptions at one pharmacy.

©   Pharmacists can play a crucial role in identifying possible drug interactions by asking patients about their herbal and other alternative medicine product use.