Hypoglycaemic effect

Bobkiewicz-Kozlowska T, Dworacka M, Kuczynski S, Abramczyk M, Kolanos R, Wysocka W, Garcia Lopez PM, Winiarska H. (2007) Hypoglycaemic effect of quinolizidine alkaloidslupanine and 2-thionosparteine on non-diabetic and streptozotocin-induced diabetic rats. Eur J Pharmacol 565 240-244. 

The peptide hormone insulin (see Box 13.1) is produced by the pancreas and plays a key role in the regulation of carbohydrate, fat, and protein metabolism, hi particular, it has a hypoglycaemic effect, lowering the levels of glucose in the blood. A malfunctioning pancreas may produce a deficiency in insulin synthesis or secretion, leading to the condition known as diabetes mellitus. This results in increased amounts of glucose in the blood and urine, diuresis, depletion of carbohydrate stores, and subsequent breakdown of fat and protein. Incomplete breakdown of fat leads to the accumulation of ketones in the blood, severe acidosis, coma, and death. 

Volatile anaesthetics, calcium channel-entry blockers, and some anti-arrhythmic drugs may potentiate the negative inotropic effect of the 3-adrenoceptor antagonists. Concomitant digoxin therapy may cause AV dissociation. Potentiation of the hypoglycaemic effects of insulin and oral antidiabetic drugs may occur. 

Galeone F, Fiore G, Mannucci E. Medium-term hypoglycaemic effects of two different oral formulations of gliclazide. Diabet Med 1999 16(7) 618-9. 

Miro, A., Quaglia, F., Sorrentino, U., La Rotonda, M. I., D Emmanuele Di Villa Bianca, R., and Sorrentino, R. 2004. Improvement of gliquidone hypoglycaemic effect in rats by cyclodextrin formulallansJ. 

Geetha, C. and Parvathi, E. P. (1990). Hypoglycaemic effect of millet incorporated breakfast on selected non-insulin dependent diabetic patients. Indian J. Nutr. Diet. 27, 316-3320. 

Irreversible MAOIs + oral hypoglycaemic drugs —> increased hypoglycaemic effect. 

Other considerations can influence the selection of the highest dose level. Rats and mice are relatively insensitive to sulfo-ureas used for the treatment of diabetes. Rats counteract the hypoglycaemic effect of these drags by secretion of glucagon and 25-hydroxy-cortisol and no hypoglycaemia occurs at the maximum dose level (> 5 000 mg/kg). In one case of a novel antidiabetic sulfonylurea it was demonstrated that absorption becomes saturated at relatively low oral dose (ca. 1000 mg/kg). This observation convinced the FDA that testing of the maximum tolerated dose (probably not determinable) is not necessary. By that the demand of test material could be reduced at least by a factor of 5. 

ASPIRIN ANTIDIABETIC DRUGS Risk of hypoglycaemia when high-dose aspirin (3.5-7.5 g/day) is given with antidiabetic agents Additive effect aspirin has a hypoglycaemic effect Avoid high-dose aspirin... 

POTASSIUM-SPARING DIURETICS REPAGUNIDE 1 hypoglycaemic effect Antagonistic effect Higher doses of repaglinide needed... 

ANION EXCHANGE RESINS ACARBOSE t hypoglycaemic effect of acarbose Uncertain Monitor blood glucose during and co-administration and after discontinuation of concurrent therapy... 

BORTEZOMIB ANTIDIABETIC DRUGS-CHLORPROPAMIDE Likely to t hypoglycaemic effect of chlorpropamide Unknown Watch for and warn patients about symptoms of hypoglycaemia - For signs and symptoms of hypoglycaemia, see Clinical Features of Some Adverse Drug Interactions, Hypoglycaemia... 

INSULIN ADRENERGIC NEURONE BLOCKERS t hypoglycaemic effect Catecholamines are diabetogenic guanethidine blocks the release of catecholamines from nerve endings Monitor blood glucose closely... 

INSULIN MUSCLE RELAXANTS -BACLOFEN 1 hypoglycaemic effect of insulin Due to these drugs causing hyperglycaemia, the mechanism being uncertain at present t doses of insulin are often required for adequate glycaemic control... 

INSULIN THYROID HORMONES 1 hypoglycaemic effect of insulin... 

SULPHONYLUREAS CHLORAMPHENICOL Possibly 1 hypoglycaemic effect of sulphonylureas Mechanism uncertain. Chloramphenicol is an inhibitor of CYP3A4 Be aware... 

SULPHONYLUREAS SULFINPYRAZONE t hypoglycaemic effect of sulphonylureas Uncertain Monitor blood glucose regularly... 

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