Drug interactions between Actos and Floxin

MONITOR: Quinolone antibiotics may interfere with the therapeutic effects of oral antidiabetic agents and insulin. The use of certain quinolones such as clinafloxacin, gatifloxacin, temafloxacin, levofloxacin, and moxifloxacin has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion. Hypoglycemia and, less frequently, hyperglycemia have been reported during use of quinolones, although the latter may also occur due to underlying infection alone. Coadministration of sulfonylureas (most often glyburide) and/or other oral hypoglycemic agents with ciprofloxacin, norfloxacin, and especially gatifloxacin has occasionally resulted in severe, refractory hypoglycemia and hypoglycemic coma. Elderly patients and patients with reduced renal function are particularly susceptible. Ciprofloxacin may also inhibit the hepatic metabolism of glyburide. Hypoglycemia in association with elevated serum glyburide level occurred in a patient after one week of ciprofloxacin therapy.

MANAGEMENT: Blood glucose should be monitored closely whenever quinolones are prescribed to patients receiving oral antidiabetic agents and/or insulin, especially if they are elderly or have renal impairment. Patients should be counseled to recognize symptoms of hypoglycemia such as headache, dizziness, drowsiness, nausea, tremor, weakness, hunger, excessive perspiration, and palpitations. If hypo- or hyperglycemia occur during quinolone therapy, patients should initiate appropriate remedial therapy immediately, discontinue the antibiotic, and contact their physician.