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Drug Interactions between Byetta and cinnamon

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

exenatide cinnamon

Applies to: Byetta (exenatide) and cinnamon

MONITOR: Coadministration of cinnamon with antidiabetic drugs and/or insulin may have additive blood glucose-lowering effects, which may potentiate the risk of hypoglycemia. Cinnamon has been shown in vitro to increase glucose uptake, glycogen synthesis and insulin sensitivity. However, clinical data are conflicting. Some small studies have reported that cinnamon reduced fasting blood glucose levels and/or glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes, whereas others have not. In a randomized control trial (RCT) in people with type 2 diabetes (n=60), it was reported that, compared to placebo, daily doses of 1 g, 3 g, or 6 g of oral cinnamon (as Cinnamomum cassia) consumed for 40 days reduced fasting blood glucose levels by 18% to 29%. In addition, an unblinded RCT in patients with poorly controlled type 2 diabetes managed in primary care in the USA (n=109) reported that the addition of oral cinnamon 1 g daily (as C. cassia) for 90 days to usual care reduced HbA1c by a statistically significant 0.83% compared to usual care alone, which lowered HbA1c by 0.37%. However, in a double-blinded, RCT in people with type 2 diabetes (n=57), compared to placebo, the administration of oral cinnamon 1 g daily (as C. cassia) for three months did not demonstrate significant differences in fasting blood glucose or HbA1c from baseline to three months. Hypoglycemia was not reported as an adverse effect in these studies.

MANAGEMENT: Until more information is available, blood glucose should be monitored if antidiabetic agents are used concomitantly with cinnamon. Patients should be advised on the potential signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia), how to treat it, and to contact their doctor if it occurs. Patients should also be advised to take precautions to avoid hypoglycemia while driving or operating hazardous machinery.

References

  1. Blevins SM, Leyva MJ, Brown J, Wright J, Scofield RH (2007) "Effect of cinnamon on glucose and lipid levels in non-insulin-dependent type 2 diabetes" Diabetes Care, 30, p. 2236-2237
  2. Khan A, Safdar M, Khan MMA, Khattak KN, Anderson RA (2003) "Cinnamon improves glucose and lipids of people with type 2 diabetes" Diabetes Care, 26, p. 3215-3218
  3. Crawford P (2009) "Effectiveness of cinnamon for lowering hemoglobin A1c in patients with type 2 diabetes: a randomised, controlled trial" J Am Board Fam Med, 22, p. 507-512

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Drug and food interactions

Moderate

exenatide food

Applies to: Byetta (exenatide)

ADJUST DOSING INTERVAL: Exenatide slows gastric emptying and may reduce the extent and rate of absorption of concomitantly administered oral medications. When acetaminophen 1000 mg was administered simultaneously with exenatide 10 mcg and also one hour, 2 hours, and 4 hours after exenatide injection, acetaminophen systemic exposure (AUC) was decreased by 21%, 23%, 24%, and 14%, respectively; peak plasma concentration (Cmax) was decreased by 37%, 56%, 54%, and 41%, respectively; and time to peak plasma concentration (Tmax) was increased from 0.6 hours in the control period to 0.9 hours, 4.2 hours, 3.3 hours, and 1.6 hours, respectively. These values were not significantly changed when acetaminophen was given one hour before exenatide injection.

MANAGEMENT: Concomitantly administered oral medications that are dependent on threshold concentrations for efficacy (e.g., antibiotics, contraceptives) or that require rapid gastrointestinal absorption (e.g., hypnotics, pain medications) should be administered at least 1 hour before exenatide. If such medications are to be administered with food, patients should be advised to take them with a meal or snack when exenatide is not administered.

References

  1. (2005) "Product Information. Byetta (exenatide)." Amylin Pharmaceuticals Inc

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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