Hypoglycemic drugs , drug interactions with

Hypoglycemia can also result from drug interactions, with the simultaneous use of drugs that have glucoselowering effects or that inhibit the clearance of oral hypoglycemic drugs. 

Table 2 Drug interactions with oral hypoglycemic drugs...

The most potentially serious drug interactions include the concomitant use of NSAIDs with lithium, warfarin, oral hypoglycemics, high-dose methotrexate, antihypertensives, angiotensin-converting enzyme inhibitors, fi-blockers, and diuretics. 

Itraconazole has significant interactions with a number of commonly prescribed drugs, such as rifampin, phenytoin, and carbamazepine. Itraconazole raises serum digoxin and cyclosporine levels and may affect the metabolism of oral hypoglycemic agents and coumadin. Absorption of itraconazole is impaired by antacids, Hj blockers, proton pump inhibitors, and drugs that contain buffers, such as the antiretroviral agent didanosine. 

Drug interactions Sandostatin has been associated with changes in nutrient absorption, so it may effect the absorption of orally administered drugs. Concomitant administration of Sandostatin with cyclosporine may decrease blood levels of cyclosporine and result in transplant rejection. Patients receiving insulin, oral hypoglycemic agents, beta blockers. 

Chloramphenicol Palmitate Chloramphenicol has concentration-dependent incompatibility with many drugs. Chloramphenicol has severe toxic effects, and overdose may be treated by hemoperfusion of charcoal. It interacts with coumarin anticoagulants, some oral hypoglycemics, antiepileptic drugs, and nutrients such as iron and vitamin B12. 

Acarbose Acarbose interacts with other hypoglycemics and drugs that act on the GI tract. Neomycin and cholestyramine interact with acarbose. 

Associated with renal dysfunction (4 PGs) and hypoglycemia. Many drug interactions (ethanol T GI bleeding, T effects of sulfonylurea hypoglycemics, and warfarin, 4 effects of uricosurics). 

Drug Interactions Contraceptive effects are decreased when "the pill" is taken with ANTIDIOTICS (ampicillin, isoniazid, neomycin, pen V, rifampin, sulfonamides, tetracycline) or CNS AGENTS (barbiturates, benzodiazepines, phenytoin). Contraceptives increase the effects of corticosteroids and worsen side effects of tricyclic antidepressants. Oral contraceptives decrease the effectiveness of oral anticoagulants, anticonvulsants, and oral hypoglycemic agents. 

Insulin-Drug Interactions Many drugs alter blood glucose levels. Increased glucose renders diabetes control difficult, even with insulin. Decreased blood glucose levels may precipitate hypoglycemic episodes. 

Interactions with the following drugs may increase the risk of hypoglycemia other hypoglycemics, sulfonamides, propranolol, salicylates, clofibrate, probenecid, pentamidine, valproic acid, dicumarol, cimetidine, MAO inhibitors, and alcohol. In addition, co-ingestion of alcohol may occasionally produce a disulfiram-like interaction (see p 186). 

Drug interactions occur with many commonly prescribed medications such as oral hypoglycemic agents, valproic acid, methotrexate, lithium, and ACE inhibitors. 

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