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Drug Interactions between Glumetza and levoketoconazole

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

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Interactions between your drugs

Major

metFORMIN levoketoconazole

Applies to: Glumetza (metformin) and levoketoconazole

Consumer information for this interaction is not currently available.

MONITOR CLOSELY: Coadministration with levoketoconazole may significantly increase the plasma concentrations of metformin. The proposed mechanism is inhibition of organic cation transporter 2 (OCT2) and multidrug and toxin extrusion transporter 1 (MATE1) by levoketoconazole, resulting in decreased renal tubular secretion and clearance of metformin. When metformin was administered concomitantly with levoketoconazole 450 mg twice daily in 17 healthy volunteers, metformin peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 182% and 220%, respectively, compared to administration of metformin alone.

MANAGEMENT: Caution is advised when metformin must be prescribed with levoketoconazole. Blood glucose, renal function, and adverse effects (e.g., diarrhea, nausea, vomiting, flatulence, indigestion, vitamin B12 deficiency) should be monitored more closely during dosage titration of levoketoconazole, and the metformin dosage adjusted accordingly. Although rare, an increased risk of lactic acidosis should also be considered, particularly in the elderly and patients with renal impairment.

References

  1. "Product Information. Recorlev (levoketoconazole)." Xeris Pharmaceuticals Inc (2023):

Drug and food interactions

Major

metFORMIN food

Applies to: Glumetza (metformin)

MetFORMIN should be taken with meals, and excessive alcohol intake (either short-term binge drinking or frequent consumption) should be avoided during treatment. Taking metFORMIN with alcohol may increase the risk of a rare but serious and potentially life-threatening condition known as lactic acidosis, which is a buildup of lactic acid in the blood that can occasionally occur during treatment with metformin-containing products. Lactic acidosis is more likely to occur if you have kidney or liver disease, acute or unstable congestive heart failure, or dehydration. You should seek immediate medical attention if you develop potential signs and symptoms of lactic acidosis such as fatigue, weakness, muscle pain, increasing drowsiness, abdominal pain or discomfort, slow or irregular heartbeat, breathing difficulty, chills, and other unusual symptoms. Alcohol may also affect blood glucose levels in patients with diabetes. Both hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) may occur, depending on how much and how often you drink. You should avoid using alcohol if your diabetes is not well controlled or if you have high triglycerides, neuropathy (nerve damage), or pancreatitis. Moderate alcohol consumption generally does not affect blood glucose levels if your diabetes is under control. However, you should limit your alcohol intake due to the risk of lactic acidosis with metformin. Avoid drinking alcohol on an empty stomach or following exercise, as it may increase the risk of hypoglycemia. Talk to your doctor or pharmacist if you have any questions or concerns about metformin.

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Moderate

levoketoconazole food

Applies to: levoketoconazole

You should avoid the use of alcohol while being treated with levoketoconazole. Levoketoconazole may cause liver damage and using it with alcohol or products containing alcohol may increase that risk. In addition, consumption of alcoholic beverages or products containing alcohol during treatment with levoketoconazole may trigger a disulfiram-like reaction in some patients, with unpleasant symptoms such as flushing, palpitations, and nausea. Levoketoconazole may be taken with or without food. You should avoid consumption of grapefruit, grapefruit juice, or any supplements that contain grapefruit extract during treatment with levoketoconazole unless directed otherwise by your doctor. Grapefruit juice may increase the blood levels of levoketoconazole. This may increase the risk and/or severity of side effects and liver problems. You should seek immediate medical attention if you develop signs and symptoms of liver damage during treatment with levoketoconazole, such as joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, light colored stools, and yellowing of the skin or eyes. Talk to your doctor if you have any questions or concerns. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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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.