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Drug Interactions Of Medications Commonly Used In Diabetes

These Medication Interactions May Be Increasingly Harmful To Ckd And Diabetic Patients

These Medication Interactions May Be Increasingly Harmful To Ckd And Diabetic Patients

Recommended Reading: Vitamin Supplements That CKD Patients Should Consider Utilizing And Others To Avoid You likely have no pharmaceutical background and are unfamiliar with what meds you should and should not ever mix. The Centers of Disease Control and Prevention estimates that 700,000 emergency room department visits and 120,000 hospitalizations annually are due to adverse drug events including negative drug interactions. While these figures may be startling, there are things you can do to keep yourself safe. Recommended Reading: Important Things Emergency Rooms Won't Tell You That Chronic Kidney Disease Patients Ought To Know Most know that by following your Nephrologists directions carefully when taking medication it limits risk. However even for Nephrologists it is difficult to predict exactly when a negative interaction will surface. Moreover, the type of medications you take, your age, diet, disease, and overall health can all affect your risk. There are three important types of drug interactions: Recommended Reading: How to Deal with the High Priced Kidney Transplant Anti-Rejection Drugs Drug-Drug Interactions occur when two or more drugs interact with each other. Many associate Drug-Drug Interactions with prescription drugs and over-the-counter drugs. Yet vitamins, supplements and herbal products can also cause harmful side effects. For instance, the herbal supplement Ginkgo Bilboa can cause excessive bleeding if taken with aspirin. Recommended Reading: Are "Natural" Supplement Products Safe and Beneficial for CKD Health? Drug-Food Interactions occur when a drug interacts with something you eat or drink. For instance, dairy products, such as milk, yogurt and cheese, can interfere with the absorption of antibiotics into the bloodstream making them less effecti Continue reading >>

Drug Interactions Diabetics Should Avoid

Drug Interactions Diabetics Should Avoid

Patients with diabetes have a higher pill burden than the general population, so pharmacists should pay particular attention to potential drug interactions with antidiabetic agents. Drug interactions may decrease medication efficacy or increase toxicity, and greater pill burden challenges adherence and adds to adverse effects. Past research has shown that the benefits of carefully selected cardiovascular medications outweigh their risks. In addition, pharmacists should know the following facts: Sulfonylureas, thiazolidinediones, meglitinides, and dipeptidyl-peptidase-4 inhibitors (DDP-4s) are most susceptible to interactions. Glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose transport protein (SGLT-2) inhibitors are least affected by drug interactions. Clinicians should consider altered absorption and transporter action, herbal supplements, and cytochrome (CYP) P450 interactions when selecting medications for patients with diabetes. A team of researchers recently addressed the pharmacodynamic and pharmacokinetic interactions of antidiabetic drugs in a new study published in the April 2016 issue of Therapeutic Advances in Endocrinology and Metabolism. The study authors conducted a literature review using the terms drug interactions, diabetes mellitus, type 2/drug therapy, humans, and hypoglycemic agents/adverse effects. They also created a summary document that reminded pharmacists about the likelihood of drug interactions concisely and thoroughly. Here were some of their significant findings: Sulfonylurea-induced hypoglycemia is worsened by co-administration with azole antifungals, clarithromycin, verapamil, angiotensin-converting enzyme (ACE) inhibitors, DPP-4s, and GLP-1 agonists. Metformin toxicity is more likely with anticholinergics because of increased Continue reading >>

Drug Interactions Of Medications Commonly Used In Diabetes

Drug Interactions Of Medications Commonly Used In Diabetes

When patients are diagnosed with diabetes, a large number of medications become appropriate therapy. These include medications for dyslipidemia, hypertension, antiplatelet therapy, and glycemic control. So many medications can be overwhelming, and it is imperative that patients are thoroughly educated about their drug regimen. Patients have many concerns when multiple medications are started, including prescribing errors, the cost of medications, and possible adverse effects. Significantly, 58% of patients worry that they will be given medications that have drug interactions that will adversely affect their health.1 These worries are not unfounded given that several highly publicized drugs have been withdrawn from the U.S. market in the past several years because of adverse effects from drug interactions. Terfenadine, mibefradil, and cisapride have all been withdrawn from the market specifically because of drug-drug interactions. When terfenadine or cisapride were given with a strong inhibitor of their metabolism, torsades de pointes, a life-threatening drug-induced ventricular arrhythmia associated with QT prolongation, could occur.2 Cisapride, for gastroparesis or gastrointestinal reflux disease, and mibefradil, for hypertension, were prescribed for many patients with diabetes. An adverse drug interaction is defined as an interaction between one or more coadministered medications that results in the alteration of the effectiveness or toxicity of any of the coadministered medications. Drug interactions can be caused by prescription and over-the-counter medications, herbal products or vitamins, foods, diseases, and genetics (family history). The true incidence of drug interactions is unknown because many are not reported, do not result in significant harm to patients, o Continue reading >>

Important Drug-drug/drug-supplement Interactions With Type 2 Diabetes Medications

Important Drug-drug/drug-supplement Interactions With Type 2 Diabetes Medications

Type 2 diabetes (T2D) is an unfortunate reality for many patients who are seen in primary care settings on a regular basis. It is important to be aware of drug–drug and drug–supplement interactions with these patients. When treating these patients for acute and chronic illnesses beyond their T2D diagnosis, clinicians should inquire about any dietary supplements and medications they may be taking. It is alarming that fewer than 40% of patients reveal their use of dietary supplements to their health care provider, when an estimated 20% to 30% of people on prescription medicine take some form of botanical supplement. For that reason, a complete drug and supplement inventory must be part of the patient intake process at each visit. Most clinicians use electronic medical software that will alert when such interactions are present. However, although this software helps to monitor for interactions, it can be fallible. It is important that clinicians be aware of some of the most common interactions with T2D medications and not rely solely on electronic software to flag such interactions. The majority of patients with T2D are on some form of oral antidiabetic agent. Patients are most commonly prescribed biguanides (eg, metformin), historically followed by insulin secretagogues such as sulfonylureas (eg, glipizide) and meglitinides (eg, repaglinide). Other newer drugs now commonly seen include alpha glucosidase inhibitors (eg, acarbose), dipeptidyl peptidase-4 inhibitors (eg, sitagliptin), glucagon-like peptide receptor agonists (eg, exenatide), sodium glucose cotransporter 2 inhibitors (eg, canaglifl ozin), and thiazolidinediones. In addition to these agents, many patients with T2D are also on insulin therapy. The most common co-morbidities in patients with T2D are hyperchol Continue reading >>

Interactions Between Antidiabetic Drugs And Herbs: An Overview Of Mechanisms Of Action And Clinical Implications

Interactions Between Antidiabetic Drugs And Herbs: An Overview Of Mechanisms Of Action And Clinical Implications

Abstract Diabetes is a complex condition with a variety of causes and pathophysiologies. The current single target approach has not provided ideal clinical outcomes for the treatment of the disease and its complications. Herbal medicine has been used for the management of various diseases such as diabetes over centuries. Many diabetic patients are known to use herbal medicines with antidiabetic properties in addition to their mainstream treatments, which may present both a benefit as well as potential risk to effective management of their disease. In this review we evaluate the clinical and experimental literature on herb–drug interactions in the treatment of diabetes. Pharmacokinetic and pharmacodynamic interactions between drugs and herbs are discussed, and some commonly used herbs which can interact with antidiabetic drugs summarised. Herb–drug interactions can be a double-edged sword presenting both risks (adverse drug events) and benefits (through enhancement). There is a general lack of data on herb–drug interactions. As such, more rigorous scientific research is urgently needed to guide clinical practice as well as to safeguard the wellbeing of diabetes patients. Keywords Herb–drug interactionsAntidiabetic drugsAntidiabetic herbsPharmacokinetic interactionPharmacodynamics interactionSynergism Background Diabetes mellitus refers to a group of chronic metabolic diseases which are generally characterised by hyperglycaemia, which eventually leads to damage of multiple body systems. There are two types of diabetes, type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. T1DM is referred as insulin-dependent diabetes mellitus (IDDM) and is caused by the impaired production of insulin. T2DM, however, is commonly associated with the inability of cells to respond to in Continue reading >>

Drug-disease And Drug-drug Interactions: Systematic Examination Of Recommendations In 12 Uk National Clinical Guidelines

Drug-disease And Drug-drug Interactions: Systematic Examination Of Recommendations In 12 Uk National Clinical Guidelines

Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines BMJ 2015; 350 doi: (Published 11 March 2015) Cite this as: BMJ 2015;350:h949 Siobhan Dumbreck, research pharmacist 1 , Martin Wilson, consultant physician for care of elderly 3 , Shaun Treweek, professor of health services research 4 , Stewart W Mercer, professor of primary care research 5 , Katherine Payne, professor of health economics 7 , Bruce Guthrie, professor of primary care medicine 1 1University of Dundee, Mackenzie Building, Dundee DD2 4BF, UK 2Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland, Edinburgh EH12 9EB, UK 3Raigmore Hospital, Inverness IV2 3UJ, UK 4University of Aberdeen, Health Services Research Unit, Foresterhill, Aberdeen AB25 2ZD, UK 5University of Glasgow, Institute of Health and Wellbeing, Glasgow G12 9LX, UK 6Centre for Clinical Practice, National Institute for Health and Care Excellence, Manchester M1 4BD 7Manchester Centre for Health Economics, Jean McFarlane Building, University of Manchester, Manchester M13 9PL, UK Correspondence to: B Guthrie B.Guthrie{at}dundee.ac.uk Objective To identify the number of drug-disease and drug-drug interactions for exemplar index conditions within National Institute of Health and Care Excellence (NICE) clinical guidelines. Design Systematic identification, quantification, and classification of potentially serious drug-disease and drug-drug interactions for drugs recommended by NICE clinical guidelines for type 2 diabetes, heart failure, and depression in relation to 11 other common conditions and drugs recommended by NICE guidelines for thos Continue reading >>

Drug Interactions With Diabetes

Drug Interactions With Diabetes

Patients with diabetes often receive many other medications in addition to their oral or injectable diabetes agents. If confronted with a loss of glycemic control, providers should investigate whether or not concomitant drug therapy may be contributing. This is of particular consideration when starting a new medication or increasing dosages. The theorized mechanisms for these interactions include decreased peripheral insulin sensitivity, decreased insulin secretion and/or increased gluconeogenesis. This article summarizes information on a core group of medications to be suspected in cases of decreased glycemic control. Corticosteroids The route of administration and the dose are factors that determine the impact of this class on blood glucose. Lower risk is associated with inhaled and topical formulations vs. oral formulations. The effect on blood glucose may be dramatic and prolonged, requiring dose increases in diabetes medications to achieve glycemic control during concomitant therapy. Atypical antipsychotics These medications have been frequently reported to be associated with significant increases in weight, diabetes (even diabetic ketoacidosis) and may have an adverse effect on lipids. The weight gain appears to be rapid, within the first few months of therapy, but may not plateau for as long as one year after treatment initiation. The increase in weight is widely variable (2 to 10 kg) and is reportedly due to an increase in body fat, suggesting insulin resistance as the mechanism. The relative risk of hyperglycemia and weight gain varies between agents within this class. Clozapine (Clozaril, Novartis) and olanzepine (Zyprexa, Eli Lilly) appear to be ranked highest. Switching patients to the lowest risk agents aripiprazole (Abilify, Otsuka America/Bristol-Myers Sq Continue reading >>

Diabetes In The Elderly: Drug Use And The Risk Of Drug Interaction

Diabetes In The Elderly: Drug Use And The Risk Of Drug Interaction

Diabetes in the elderly: drug use and the risk of drug interaction Maria Aparecida Medeiros Barros doPrado 1 Priscila Maria Stolses BergamoFrancisco 1 1Departamento de Sade Coletiva, Faculdade de Cincias Mdicas, Unicamp. R. Carlos Gomes 241, Cidade Universitria. 13083-970 Campinas SP Brasil. [email protected] This study sought to outline the sociodemographic and health profile of elderly persons with reported diabetes, to assess the knowledge and practices regarding treatment options and describe the use of medications and potential risks for drug interactions (DI) in this subgroup. In 2008,a cross-sectional study was conducted of 1,517 elderly citizens in Campinas in which the prevalence of diabetes was estimated and its associations assessed using the Rao-Scott test (p < 0,05).The potential drug interactions were evaluated using the Micromedex database. Diabetes prevalence was 21.7%, without significant difference between the sexes. A higher percentage of elderly diabetics was found aged over 70, with less schooling, per capita family income of less than 1 minimum wage and no occupational activity. The average drug intake was 3.9 in the previous 3 days. Possible interactions were identified in 413 cases and 53.1%, 7.8% and 7.2% of the subjects presented moderate, minor and serious risk of DI, respectively. The importance of adopting a healthy diet and physical activity for weight reduction, disease and complication control is stressed. The need for attention to the potential for drug interactions and the use of inappropriate medications among the elderly is highlighted. Key words: Diabetes Mellitus; Use of medication; Drug interaction; Health of the elderly; Health survey Diabetes mellitus (DM or diabetes) is currently one of the leading chronic non-communicable dis Continue reading >>

Drug Interactions Diabetics Should Avoid

Drug Interactions Diabetics Should Avoid

Patients with diabetes have a higher pill burden than the general population, so pharmacists should pay particular attention to potential drug interactions with antidiabetic agents. Drug interactions may decrease medication efficacy or increase toxicity, and greater pill burden challenges adherence and adds to adverse effects. Past research has shown that the benefits of carefully selected cardiovascular medications outweigh their risks. In addition, pharmacists should know the following facts: · Sulfonylureas, thiazolidinediones, meglitinides, and dipeptidyl-peptidase-4 inhibitors (DDP-4s) are most susceptible to interactions. · Glucagon-like peptide-1 (GLP-1) agonists and sodium-glucose transport protein (SGLT-2) inhibitors are least affected by drug interactions. · Clinicians should consider altered absorption and transporter action, herbal supplements, and cytochrome (CYP) P450 interactions when selecting medications for patients with diabetes. A team of researchers recently addressed the pharmacodynamic and pharmacokinetic interactions of antidiabetic drugs in a new study published in the April 2016 issue of Therapeutic Advances in Endocrinology and Metabolism. The study authors conducted a literature review using the terms drug interactions, diabetes mellitus, type 2/drug therapy, humans, and hypoglycemic agents/adverse effects. They also created a summary document that reminded pharmacists about the likelihood of drug interactions concisely and thoroughly. Here were some of their significant findings: · Sulfonylurea-induced hypoglycemia is worsened by co-administration with azole antifungals, clarithromycin, verapamil, angiotensin-converting enzyme (ACE) inhibitors, DPP-4s, and GLP-1 agonists. · Metformin toxicity is more likely with anticholinergics because Continue reading >>

Metformin Hcl

Metformin Hcl

Uses Metformin is used with a proper diet and exercise program and possibly with other medications to control high blood sugar. It is used in patients with type 2 diabetes. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual function problems. Proper control of diabetes may also lessen your risk of a heart attack or stroke. Metformin works by helping to restore your body's proper response to the insulin you naturally produce. It also decreases the amount of sugar that your liver makes and that your stomach/intestines absorb. How to use Metformin HCL Read the Patient Information Leaflet if available from your pharmacist before you start taking metformin and each time you get a refill. If you have any questions, consult your doctor or pharmacist. Take this medication by mouth as directed by your doctor, usually 1-3 times a day with meals. Drink plenty of fluids while taking this medication unless otherwise directed by your doctor. The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products). To reduce your risk of side effects (such as upset stomach), your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. Take this medication regularly in order to get the most benefit from it. Remember to use it at the same times each day. If you are already taking another diabetes drug (such as chlorpropamide), follow your doctor's directions carefully for stopping/continuing the old drug and starting metformin. Check your blood sugar regularly a Continue reading >>

Drug Interaction Potential Of Antidiabetic Medications

Drug Interaction Potential Of Antidiabetic Medications

Drug Interaction Potential of Antidiabetic Medications Polypharmacy is common in patients with diabetes Diabetes occurs comorbidly with many other medical conditions, such as hypertension, dyslipidemia and central nervous system disorders.1 The multifactorial pharmacotherapy necessitated by these conditions leads to a higher risk of adverse drug effects and interactions.1 Specific issues of concern are cytochrome P-450 (CYP) enzyme interactions, altered absorption properties, and transporter activities. Added to the complex picture of potential drug interaction risk are nutritional factors, herbal supplements, and other parameters such as the patient's age and gender.1 A recent literature review by May and Schindler2 examines the pharmacokinetic and pharmacodynamic properties of antidiabetic drugs and their clinically relevant interactions. The authors define a drug interaction as either an increase or decrease of a medical diagnostic or therapeutic effect of a specific drug caused by another substance, which may be another drug, plant, or a dietary supplement. They divide interactions into two categories: pharmacokinetic and pharmacodynamic. Pharmacokinetic interactions influence absorption, distribution, metabolism, or excretion of a drug (ADME rule) and thus lead to increased or reduced plasma levels of a drug, with each drug affecting the metabolic pathway of the other concomitantly taken drug.1 This leads to either increased or decreased plasma levels of one or both, compared with the plasma levels if each drug were taken separately.2 The mechanism of pharmacokinetic interaction often involves inhibition, induction, or degradation of liver enzymes,3 typically based on oxidative metabolism by the CYP enzyme system or an interaction with the drug transported P-glyco Continue reading >>

Drug Interactions With Oral Hypoglycaemic Drugs

Drug Interactions With Oral Hypoglycaemic Drugs

Oral hypoglycaemic drugs may interact with other drugs. Pharmacodynamic interactions occur with medications that alter blood glucose and may require the dose of the oral hypoglycaemic drug to be altered. Pharmacokinetic interactions vary with the drug group. Sulfonylureas and repaglinide are metabolised in the liver. Their plasma concentrations and activity can be reduced by drugs which induce hepatic enzymes and increased by hepatic enzyme inhibitors. Metformin is renally excreted and may have increased toxicity with drugs that impair renal function. Acarbose is only slightly absorbed across the gut and has few significant interactions. Significant interactions with the thiazolidinediones have not yet been reported, but pioglitazone is known to induce cytochrome P450 3A4. SYNOPSIS Oral hypoglycaemic drugs may interact with other drugs. Pharmacodynamic interactions occur with medications that alter blood glucose and may require the dose of the oral hypoglycaemic drug to be altered. Pharmacokinetic interactions vary with the drug group. Sulfonylureas and repaglinide are metabolised in the liver. Their plasma concentrations and activity can be reduced by drugs which induce hepatic enzymes and increased by hepatic enzyme inhibitors. Metformin is renally excreted and may have increased toxicity with drugs that impair renal function. Acarbose is only slightly absorbed across the gut and has few significant interactions. Significant interactions with the thiazolidinediones have not yet been reported, but pioglitazone is known to induce cytochrome P450 3A4. Index words: diabetes, pharmacokinetics, lactic acidosis. (Aust Prescr 2001;24:83-5) Introduction The sulfonylureas and metformin (a biguanide) have been the mainstay of drug treatment for type 2 diabetes. Recently three ne Continue reading >>

Clinically And Pharmacologically Relevant Interactions Of Antidiabetic Drugs

Clinically And Pharmacologically Relevant Interactions Of Antidiabetic Drugs

Go to: Introduction Patients with type 2 diabetes mellitus (T2DM) often do not suffer solely from symptoms of increased blood glucose levels. In the majority of cases, several comorbidities are present with the need of additional pharmacological treatment. Concomitant diseases such as hypertension and high blood lipids can lead to both microvascular and macrovascular complications [Cornier et al. 2008]. Moreover, central nervous disorders such as depression are increased in patients with T2DM compared with the general population [Anderson et al. 2001]. Multifactorial pharmacotherapy significantly reduces the risk of cardiovascular (CV) mortality [Gaede et al. 2008], but an increasing number of medications taken by the patients leads to a higher risk of adverse drug effects and interactions [Freeman and Gross, 2012; Amin and Suksomboon, 2014; Rehman et al. 2015; Valencia and Florez, 2014; Peron et al. 2015]. Applying a multifactorial pharmacotherapy approach, it is important to consider cytochrome P-450 (CYP) enzyme interactions [De Wildt et al. 1999; Dresser et al. 2000], altered absorption properties [Fleisher et al. 1999] and transporter activities [Lin and Yamazaki, 2003]. Furthermore, nutrition [Fleisher et al. 1999], herbal supplements [Rehman et al. 2015] and other parameters such as patient’s age and gender [Meibohm et al. 2002; Mangoni and Jackson, 2004] are of importance when the drug interaction risk of a pharmacological therapy is assessed. This article provides a short review of the pharmacokinetic and pharmacodynamic properties of antidiabetic drugs and their clinically relevant interactions with common medications which are frequently used to treat diabetic comorbidities. Literature searches included PubMed and Scopus databases using the Medical Subject Continue reading >>

Dangerous Drug Combinations

Dangerous Drug Combinations

People with diabetes often have a number of coexisting health problems. So in addition to insulin or diabetes pills, other drugs are often needed to control these problems — statins for high cholesterol, diuretics or beta-blockers for high blood pressure, antidepressants for depression or neuropathy pain, and a daily aspirin to prevent a heart attack. But some drugs are not supposed to be taken simultaneously, and doctors and pharmacists don’t always notice when a person is taking dangerous or risky drug combinations. What can happen to you if you take several drugs that are not supposed to be taken together? This article explains why and how medicines can interact and what a drug interaction may mean for you and your health care. The scope of the problem Surprisingly, most drug reactions are caused by a small group of commonly prescribed drugs. The nonsteroidal anti-inflammatory drugs (such as ibuprofen), anticoagulants, diuretics, and drugs to treat diabetes are on this list. Adverse drug reactions may add as much as $130 billion a year to the cost of health care in the United States. A significant portion of adverse drug reactions are caused by interacting drugs. This is a huge problem and much research and effort is going into trying to reduce the incidence and risk of these interactions. It is estimated that people over 65 take an average of seven drugs at any one time to treat a variety of illnesses. With this amount of medicine use, the probability that a person will take two prescribed drugs that may interact with one another is very high. In a recent study done in six European countries, investigators reviewed the medicines taken by about 1600 people and found that 46% were taking at least one pair of drugs that could interact. (Studies that include people Continue reading >>

Metformin Drug Interactions

Metformin Drug Interactions

A total of 702 drugs (4976 brand and generic names) are known to interact with metformin. Show all medications in the database that may interact with metformin. Check for interactions with metformin Type in a drug name and select a drug from the list. Common medications checked in combination with metformin metformin alcohol/food Interactions There is 1 alcohol/food interaction with metformin FDA-Approved Weight-Loss Drug - Once-Daily Treatment Need Obesity Help? Learn About an Option That May Help You Reach Your Goal. Prescription treatment website metformin disease Interactions There are 4 disease interactions with metformin which include: The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables. Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. Unknown No information available. Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, Continue reading >>

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