Hypoglycaemics, oral

Oral hypoglycaemic agents Oral blood glucoselowering drugs Insulin secretagogues Antihypergly-caemics... 

M. Fujimaki, N. Ishigaki, H. Hakusui, Metabolic Fate of the Oral Hypoglycaemic Agent, Midaglizole, in Rats , Xenobiotica 1989, 19, 609-625. 

Repaglinide is a newer oral hypoglycaemic agent, indicated in type 2 diabetes either in combination with metformin or as monotherapy. Repaglinide stimulates insulin release. 

Cholestatic hepatitis Phenothiazines Oral hypoglycaemics Erythromycin estolate... 

II.f.2.1. Oral hypoglycaemic agents. There are now five groups of orally active drugs available to lower blood glucose in clinical practice (Table 2). These are sulphonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and the incretin derivatives. 

Accumulation of metformin can occur in patients with renal insufficiency, and interference with pyruvate metabolism can lead to severe lactic acidosis. Lactic acidosis is more likely in situations associated with anaerobic metabolism, and metformin should not be given to patients with renal disease, liver disease, or severe pulmonary or cardiac disease predisposing to hypoxia. It is recommended to switch patients taking metformin to another oral hypoglycaemic prior to cardiac or other major surgery. 

Howes LG, Sundaresan P, Lykos D. Cardiovascular effects of oral hypoglycaemic drugs. Clin Exp Pharmacol Physiol 1996 23(3) 201-6. 

Comparison of repaglinide vs gliclazide in combination with bedtime NPH insulin in patients with type 2 diabetes inadequately controlled with oral hypoglycaemic agents. Diabetic Med 2003 20 935 11. 

Goudswaard AN, Stolk RP, de Zuithoff P, Valk HW, Rutten GE. Starting insulin in type 2 diabetes continue oral hypoglycaemic agents J Fam Pract 2004 53 393-9. 

Bertini AM, Silva JC, Taborda W, Becker F, Bebber FRL, Viesi JMZ, Aquim G, Ribeiro TE. Perinatal outcomes and the use of oral hypoglycaemic agents. J Perinat Med 2005 33 519-23. 

Piacquadio K, Hollingsworth DR, Murphy H. Effects of in-utero exposure to oral hypoglycaemic drugs. Lancet 1991 338(8771) 866-9. 

Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2004 CD003418. 

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

AMPHETAMINES BUPROPION 1. t plasma concentrations of these substrates, with risk of toxic effects 2. t risk of seizures. This risk is marked in elderly people, patients with a history of seizures, those with an addiction to opiates/ cocaine/stimulants, and those with diabetes treated with oral hypoglycaemics or insulin 1. Bupropion and its metabolite hydroxybupropion inhibit CYP2D6 2. Bupropion is associated with a dose-related risk of seizures. These drugs that lower seizure threshold are individually epileptogenic. They have additive effects when combined 1. Initiate therapy with these drugs, particularly those with a narrow therapeutic index, at the lowest effective dose. Interaction is likely to be important with substrates for which CYP2D6 is considered the only metabolic pathway (e.g. amphetamines) 2. Extreme caution. The dose of bupropion should not exceed 450 mg/day (or 150 mg/day in those with severe hepatic cirrhosis)... 

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