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Drug Interactions between insulin lispro and tigecycline

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

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Interactions between your drugs

Moderate

insulin lispro tigecycline

Applies to: insulin lispro and tigecycline

MONITOR: Tetracyclines may enhance the hypoglycemic effect of insulin. The exact mechanism is unknown; however, proposed mechanisms include increasing the sensitivity of insulin, increasing the half-life of insulin via inhibition of insulin degradation in the liver, interference with epinephrine-induced hyperglycemia via inhibition of glycogenolysis, and tetracycline-induced hepatotoxicity. The authors of one study suggest that tetracycline may be able to inhibit alpha-amylase and/or alpha-glucosidase as substrates for these enzymes have similar functional groups to those found in tetracycline. There are case reports available documenting hypoglycemia for patients on doxycycline and one case report demonstrating improved insulin sensitivity in a patient on minocycline. It is possible that other tetracyclines may possess similar abilities to lower glucose levels.

MANAGEMENT: Blood glucose should be monitored more closely during therapy with a tetracycline antibiotic. As the effects of the antibiotic may last past the last dose, it is possible that patients may need to be monitored more closely until the antibiotic is fully eliminated from their body, which will differ based on the half-life of the antibiotic involved. The insulin dosage may require an adjustment if an interaction is suspected. Patients should be counseled on the signs and symptoms of hypoglycemia (e.g., fast heartbeat, shaking, sweating, anxiety, irritability, confusion, dizziness, and/or hunger), how to treat it, and to contact their physician if it occurs unexpectedly.

References

  1. Dalpe-Scott M, Heick HM, Begin-Heick N (1983) "Insulin secretion in the obese (ob/ob) mouse: the effect of oxytetracycline on insulin release." Diabetes, 32, p. 932-7
  2. Dalpe-Scott M, Begin-Heick N (1982) "Oxytetracycline treatment improves the response to insulin in the spontaneously diabetic (BB) rat." Diabetes, 31, p. 53-9
  3. Begin-Heick N, Heick HM, Norman MG (1979) "Regranulation of Islets of Langerhans and normalization of in vivo insulin secretion in ob/ob mice treated with oxytetracycline." Diabetes, 28, p. 65-70
  4. Phillips PJ, Easterbrook G (1977) "Phenformin, tetracycline and lactic acidosis." Ann Intern Med, 86, p. 111
  5. Miller JB (1966) "Hypoglycaemic effect of oxytetracycline." BMJ, 2, p. 1007
  6. Hiatt N, Bonorris G (1970) "Insulin response in pancreatectomized dogs treated with oxytetracycline." Diabetes, 19, p. 307-11
  7. Amiri B, Hosseini NS, Taktaz F, et al. (2019) "Inhibitory effects of selected antibiotics on the activities of alpha-amylase and alpha-glucosidase: In-vitro, in-vivo and theoretical studies" Eur J Pharm Sci, 138, p. 1-16
  8. Kennedy KE, Teng C, Patek TM, Frei CR (2020) "Hypoglycemia associated with antibiotics alone and in combination with sulfonylureas and meglitinides: an epidemiologic surveillance study of the FDA adverse event reporting system (FAERS)." Drug Saf, 43, p. 363-9
  9. Ashraf S, Saberinia H, Desimone M (2018) "Doxycycline induced hypoglycemia in an adult without diabetes." J Basic Clin Pharma, 9, p. 115-7
  10. Douglas Y, grant mb, Moshiree B (2023) Case report open access minocycline attenuates severe hyperglycemia in patient with lipodystrophy. https://www.omicsonline.org/open-access/minocycline-attenuates-severe-hyperglycemia-in-patient-with-lipodystrophy-ijm-1000136.php?aid=76310
  11. Ijete E, Hosni M, Dadey E, Nikookam K, Rehmani H, Mlawa G (2022) "Uncommon side effect of a common drug: doxycyline induced hypoglycemia." Endocrine Abstracts, 81, P347
View all 11 references

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Drug and food interactions

Moderate

insulin lispro food

Applies to: insulin lispro

GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

References

  1. Jerntorp P, Almer LO (1981) "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand, 656, p. 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. (1983) "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol, 24, p. 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. (1983) "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia, 24, p. 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A (1987) "Interaction of ethanol and glipizide in humans." Diabetes Care, 10, p. 683-6
  5. (2002) "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals
  6. (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM (1981) "The pharmacology of sulfonylureas." Am J Med, 70, p. 361-72
  9. (2002) "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care, 25(Suppl 1), S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics."
View all 10 references

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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

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