Sulphonylureas Beta blockers

ANTICOAGULANTS - ORAL 5. ANTIDEPRESSANTS - mianserin, paroxetine 6. ANTIDIABETIC DRUGS - repaglinide, sulphonylureas 7. ANTIEMETICS - aprepi-tant 5-HT3-antagonists 8. ANTIFUN-GALS - fluconazole, itraconazole, ketoconazole, voriconazole 9. ANTIPSY-CHOTICS - apiprazole, chlorpromazine, haloperidol 10. BETA-BLOCKERS-metoprolol, propanolol, timolol... 

Effects on blood glucose. The sulphonylurea-induced insulin-release from the pancreas can he inhihited by beta blockers so that the blood glucoselowering effects are opposed to some extent. 

Non-selective beta blockers can also block beta-2 receptors in the pancreas concerned with insulin-release, so that the effects of the sulphonylureas may be blocked. 

Diabetics taking oral sulphonylureas rarely seem to have serious hypoglycaemic episodes caused by beta blockers, and any reductions in the blood glucose-lowering effects of the sulphonylureas normally appear to be of little clinical importance. The selective beta blockers are probably safer than those that are non-selective. Nevertheless, always monitor concurrent use to confirm that diabetic control is well maintained, adjusting the dose of antidiabetic as necessary, and warn all patients (as above) that some of the premonitory signs of hypoglycaemia may not occur. 

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