Drug Interactions of antidiabetics (Part 2) - PowerPoint PPT Presentation

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Drug Interactions of antidiabetics (Part 2)

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Drug interactions of Incretin mimetics (Exenatide) with other drugs like Warfarin, Digoxin, Paracetamol, Antibacterials, Thyroid hormones, Danazol and ACE inhibitors are dealt in this presentation. The interactions of Amylin analogue (Pramlintide) with other drugs such as Alpha glucosidase inhibitors, Danazol, ACE inhibitors, Thyroid hormones, Paracetamol and Antimuscarinics are also dealt in this presentation. – PowerPoint PPT presentation

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Title: Drug Interactions of antidiabetics (Part 2)


1
Drug Interactions of antidiabetics(part 2)
  • Dr.P.Naina Mohamed
  • Pharmacologist

2
Antidiabetic Drugs
  • PARENTERAL ANTIDIABETIC DRUGS
  • Insulins
  • Rapid acting insulins
  • Regular insulin (Humulin R, Novolin R)
  • Insulin lispro (Humalog)
  • Insulin aspart (Novolog)
  • Insulin glulisine (Apidra)
  • Prompt insulin zinc (Semilente, Slightly slower
    acting)
  • Intermediate acting insulins include
  • Isophane insulin, neutral protamine Hagedorn
    (NPH) (Humulin N, Novolin N)
  • Insulin zinc (Lente)
  • Long acting insulins include
  • Extended insulin zinc insulin (Ultralente)
  • Insulin glargine (Lantus)
  • Insulin detemir (Levemir)
  • Incretin Mimetics (Glucagon-like peptide
    analogues)
  • Exenatide (Exendin-4, Byetta) - First GLP-1
    agonist.
  • Liraglutide (Victoza) - once-daily human
    analogue.
  • Taspoglutide - Presently in Phase III clinical
    trials.

3
Antidiabetic Drugs
  • ORAL ANTIDIABETIC DRUGS
  • Secretagogues
  • Sulfonylureas
  • First-generation agents
  • Tolbutamide (Orinase), Acetohexamide (Dymelor),
    Tolazamide (Tolinase), Chlorpropamide (Diabinese)
  • Second-generation agents
  • Glipizide (Glucotrol), Glyburide or Glibenclamide
    (Diabeta, Micronase, Glynase), Glimepiride
    (Amaryl), Gliclazide (Diamicron), Glycopyramide,
    Gliquidone.
  • Meglitinides
  • Repaglinide (Prandin)
  • Nateglinide (Starlix)
  • Insulin sensitizers
  • Biguanides
  • Metformin (Glucophage)
  • Thiazolidinediones (TZDs)
  • Rosiglitazone (Avandia)
  • Pioglitazone (Actos)

4
Antidiabetic Drugs
  • Alpha-glucosidase inhibitors
  • Acarbose (Precose/Glucobay)
  • Miglitol (Glyset)
  • Voglibose
  • Dipeptidylpeptidase-4 inhibitors
  • Sitagliptin (Januvia)
  • Vildagliptin (Galvus)
  • Saxagliptin (Onglyza)
  • Linagliptin (Tradjenta)
  • Aldose reductase inhibitors
  • Epalrestat
  • Sodium-glucose co-transporter 2 inhibitors
  • Dapagliflozin
  • Canagliflozin

5
Interactions of incretin mimetics amylin
analogue
  • Interactions of Incretin Mimetics
  • Exenatide Warfarin Interaction
  • Exenatide Digoxin Interaction
  • Exenatide Paracetamol Interaction
  • Exenatide Antibacterials Interaction
  • Exenatide Thyroid Hormones Interaction
  • Exenatide Danazol Interaction
  • Exenatide ACE Inhibtors Interaction
  • Interactions of Amylin Analogue
  • Pramlintide Alpha glucosidase inhibitors
    Interaction
  • Pramlintide Danazol Interaction
  • Pramlintide ACE Inhibitors Interaction
  • Pramlintide Thyroid Hormones Interaction
  • Pramlintide Paracetamol Interaction
  • Pramlintide Antimuscarinics Interaction

6
Exenatide warfarin
  • Exenatide
  • Warfarin
  • May increase INR
  • Increased bleeding risk
  • Moderately severe interaction is possible between
    exenatide and warfarin.
  • More frequent monitoring of prothrombin time or
    INR when initiating or changing exenatide therapy
    is recommended.

7
Exenatide digoxin
  • Exenatide
  • Dgoxin
  • Slowed gastric emptying by exenatide
  • Decrease in digoxin plasma concentrations
  • Moderate interaction may occur between Exenatide
    and digoxin.
  • The patient should wait at least 1 hour after
    taking digoxin before using exenatide.
  • Digoxin serum levels should be measured before
    initiating exenatide, and the dose of digoxin
    should be increased by approximately 20 to 40
    as necessary.
  • Monitoring of digoxin levels and clinical
    efficacy is recommended during concomitant
    therapy.

8
Exenatide paracetamol
  • Exenatide
  • Paracetamol
  • Exenatide slows gastric emptying
  • Delayed absorption of other drugs (Paracetamol)
  • The manufacturers recommend that exenatide should
    be used with caution in patients receiving oral
    drugs that require rapid gastrointestinal
    absorption, for example, an analgesic for acute
    pain or fever.
  • It may be prudent to give the drug at least one
    hour before exenatide, or delay exenatide until
    more than 2 hours after the drug.

9
Exenatide antibacterials
  • Exenatide
  • Antibacterials
  • Exenatide slows gastric emptying
  • Delayed absorption of other drugs
    (Antibacterials)
  • The manufacturers also suggest that exenatide
    should be used with caution in patients receiving
    oral drugs that are dependent on threshold
    concentrations for efficacy, for example
    antibacterials.
  • They recommend that antibacterials should be
    taken at least one hour before exenatide.

10
Exenatide thyroid hormones
  • Exenatide
  • Thyroid hormones (Liothyronine, dextrothyroxine,
    levothyroxine, thyroglobulin)
  • Decreased effectiveness of the antidiabetic agent
  • Increased dose of exenatide may be required
  • Moderate interaction may occur between Exenatide
    and Thyroid hormones.
  • Carefully monitor diabetic control, especially
    when a thyroid hormone agent is initiated,
    changed or discontinued.

11
Exenatide danazol
  • Exenatide
  • Danazol
  • Danazol associated insulin resistance
  • Increased blood glucose levels
  • Moderate interaction may occur between Exenatide
    and Danazol.
  • Use caution with the concomitant use of danazol
    and exenatide.
  • Increased blood sugar monitoring and dose
    adjustments of antidiabetic medications may be
    warranted during coadministration and after
    discontinuation of danazol.

12
Exenatide trandolapril
  • Exenatide
  • Trandolapril
  • Increased glucose utilisation
  • increased insulin sensitivity
  • Increased risk of hypoglycemia
  • Moderate interaction may occur between exenatide
    and trandalopril.
  • More frequent blood glucose monitoring and/or
    observation for signs or symptoms of hypoglycemia
    may be necessary.

13
Pramlintide alpha glucosidase inhibitors
  • Pramlintide
  • Alpha glucosidase inhibitors
  • Pramlintide slows gastric emptying
  • Clinical study is needed
  • The manufacturer of pramlintide suggests that it
    should not be used in patients taking drugs that
    slow the intestinal absorption of nutrients, such
    as the alpha-glucosidase inhibitors.
  • Clinical study is needed to see if there is any
    important effect if the drugs are used together.
  • Patients taking alpha-glucosidase inhibitors
    should not be given pramlintide until the
    combination has been studied clinically.

14
Pramlintide danazol
  • Pramlintide
  • Danazol
  • Danazol-associated insulin resistance
  • Increased blood glucose levels
  • Moderate interaction may occur between
    pramlintide and danazol.
  • Use caution with the concomitant use of danazol
    and pramlintide.
  • Increased blood sugar monitoring and dose
    adjustments of antidiabetic medications may be
    warranted during coadministration and after
    discontinuation of danazol.

15
Pramlintide trandolapril
  • Pramlintide
  • Trandolapril
  • Increased glucose utilisation
  • increased insulin sensitivity
  • Increased risk of hypoglycemia
  • Moderate interaction may occur between
    pramlintide and trandolapril.
  • Close monitoring and dose adjustments may be
    required.

16
Pramlintide thyroid hormones
  • Pramlintide
  • Thyroid hormones (liothyronine, dextrothyroxine,
    levothyroxine, thyroglobulin)
  • Reduced efficacy of the antidiabetic agent
  • Increased dosage requirement of pramlintide
  • Moderate interaction may occur between
    pramlintide and thyroid hormones.
  • Carefully monitor diabetic control, especially
    when a thyroid hormone agent is initiated,
    changed or discontinued.

17
Pramlintide paracetamol
  • Pramlintide
  • Paracetamol
  • Pramlintide modestly slows gastric emptying
  • Delayed absorption of other drugs (Paracetamol)
  • The manufacturer recommends that if a rapid onset
    of action is required (for example when giving an
    oral analgesic), the drug should be given at
    least one hour before or 2 hours after
    pramlintide.

18
Pramlintide antimuscarinics
  • Pramlintide
  • Antimuscarinics
  • Pramlintide modestly slows gastric emptying
  • Further delay of gastric emptying
  • The manufacturer recommends that pramlintide
    should not be used in patients taking other drugs
    that alter gastrointestinal motility such as
    antimuscarinics (Atropine) which delay gastric
    emptying.

19
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.

20
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

21
References
  • 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
  • www.micromedexsolutions.com
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