Drug Interactions of Antidiabetics (Part 7): Interactions of Alpha-glucosidase inhibitors - PowerPoint PPT Presentation

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Drug Interactions of Antidiabetics (Part 7): Interactions of Alpha-glucosidase inhibitors

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Alpha-glucosidase inhibitors interact with drugs such as Digoxin, Warfarin, Sulfonylureas, Neomycin, Guar gum, Pancreatin, Amylase, Activated charcoal, Antimuscarinics, Paracetamol and Nifedipine. – PowerPoint PPT presentation

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Title: Drug Interactions of Antidiabetics (Part 7): Interactions of Alpha-glucosidase inhibitors


1
Drug Interactions of antidiabetics(part 7)
  • Dr.P.Naina Mohamed
  • Pharmacologist

2
Antidiabetic Drugs
  • Alpha-glucosidase inhibitors
  • Acarbose (Precose/Glucobay)
  • Miglitol (Glyset)
  • Voglibose
  • Alpha-glucosidase inhibitors are oral
    anti-diabetic drugs which prevent the digestion
    of carbohydrates.
  • Alpha-glucosidase inhibitors are saccharides that
    act as competitive inhibitors of enzymes needed
    to digest carbohydrates.
  • Alpha-glucosidase enzymes are found in the brush
    border of the small intestines.

3
Acarbose And Digoxin
  • Acarbose
  • Digoxin
  • Acarbose may decrease digoxin absorption
  • Subtherapeutic levels of digoxin
  • Decreased digoxin efficacy
  • Patients receiving digoxin and acarbose therapy
    should be instructed to take their medications
    consistently at the same time interval daily to
    avoid any fluctuations in their digoxin levels.
  • Digoxin levels should be appropriately monitored
    following the initiation of acarbose.

4
Acarbose And Warfarin
  • Acarbose
  • Warfarin
  • Acarbose may increase warfarin absorption
  • Enhanced anticoagulant effect of warfarin
  • Increased risk of bleeding
  • Closely monitor the international normalized
    ratio (INR) following initiation or
    discontinuation of acarbose therapy in warfarin
    patients.

5
Acarbose And Sulfonylureas
  • Acarbose
  • Sulfonylureas
  • Additive hypoglycemic effects
  • Increased hypoglycemic potential of the
    sulfonylurea
  • Monitor closely blood glucose concentrations when
    acarbose is added to or withdrawn from
    sulfonylurea therapy.
  • Doses of either or both drugs may need to be
    adjusted to minimize hypoglycemic effects.
  • Patients receiving these medications should be
    counseled to carry a supply of glucose tablets or
    glucose liquid rather than food products which
    may contain sucrose.
  • Sucrose is not effective in rapidly correcting
    hypoglycemia in acarbose-treated patients.
    Acarbose inhibits the hydrolysis of sucrose to
    glucose and fructose.

6
Acarbose And Neomycin
  • Acarbose
  • Neomycin
  • Neomycin induced hypoglycemia
  • Increased risk of hypoglycemia
  • The manufacturers suggest a temporary reduction
    in the dose of acarbose may be needed.

7
Acarbose And Guar gum
  • Acarbose
  • Guar gum
  • Delayed gastric emptying by guar gum
  • Delayed absorption of glucose from meals
  • Increased risk of hypoglycemia
  • Closely monitor blood glucose levels and signs
    and symptoms of hypoglycemia when guar gum and
    acarbose are used together.

8
Acarbose And Pancreatin
  • Acarbose
  • Pancreatin
  • Increased gastrointestinal metabolism
  • Reduced effectiveness of acarbose
  • Avoid concomitant administration of acarbose with
    pancreatin.

9
Acarbose And Amylase
  • Acarbose
  • Amylase
  • Increased gastrointestinal metabolism by Amylase
  • Reduced effectiveness of acarbose
  • Avoid concomitant administration of acarbose with
    amylase.

10
Acarbose And Activated charcoal
  • Acarbose
  • Activated charcoal
  • Binding of acarbose in the gastrointestinal tract
  • Reduced effectiveness of acarbose
  • Avoid concomitant administration of acarbose with
    intestinal adsorbents such as charcoal.

11
Acarbose And Antimuscarinics
  • Acarbose
  • Antimuscarinics
  • Increased risk of paralytic ileus
  • Patients at risk should be monitored if they are
    given alpha-glucosidase inhibitors (If the dose
    is increased) or if antimuscarinics are also
    given.
  • Sudden abdominal pain, nausea and vomiting are
    symptoms of paralytic ileus.

12
Acarbose and Paracetamol
  • Acarbose
  • Paracetamol
  • Acarbose induce CYP2E1
  • Paracetamol is metabolised to its hepatotoxic
    metabolite
  • Potentiation of hepatotoxicity of paracetamol
  • These findings require confirmation in humans,
    because animal data are not always reproduced in
    humans.

13
Acarbose And Nifedipine
  • Acarbose
  • Nifedipine
  • Nifedipine induced hyperglycemia
  • Loss of glucose control
  • When nifedipine and acarbose are co-administered,
    monitoring of blood glucose levels is
    recommended.
  • Consider dose adjustment to maintain glucose
    control.

14
Conclusion
  • The diabetics should consult their physician and
    pharmacist.
  • The diabetics should bring a list of all of the
    drugs they are taking (or simply bring the drugs
    themselves), including prescription drugs,
    over-the-counter drugs, and any supplements,
    herbal or otherwise, during their visit to the
    doctor or pharmacist.
  • They are encouraged to ask their doctor or
    pharmacist to look over their list for any
    potentially dangerous combinations.
  • It is recommended that people fill all their
    prescriptions at one pharmacy, if possible. In
    addition, they should maintain a list of all of
    their medicines and update it when one is added
    or removed.
  • They should review their list with their doctor
    or pharmacist regularly, particularly when they
    begin to take a new medicine.

15
References
  • Stockleys Drug Interactions, 9e
  • Karen Baxter
  • British National Formulary
  • June 2013
  • Basic Clinical Pharmacology, 12e Bertram
    G. Katzung, Susan B. Masters, Anthony J. Trevor
  • Goodman Gilman's The Pharmacological Basis of
    Therapeutics, 12e Laurence L. Brunton, Bruce
    A. Chabner, Björn C. Knollmann

16
References
  • http//www.micromedexsolutions.com
  • http//www.ncbi.nlm.nih.gov/pmc/articles/PMC301938
    7/
  • http//spectrum.diabetesjournals.org/content/19/4/
    202.full.pdfhtml
  • http//www.fda.gov/cder/consumerinfo/druginteracti
    ons.htm
  • http//medicine.iupui.edu/clinpharm/ddis/
  • http//www.australianprescriber.com/magazine/24/4/
    83/5
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