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Drug Interactions between sulfinpyrazone and Tol-Tab

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

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Interactions between your drugs

Moderate

sulfinpyrazone TOLBUTamide

Applies to: sulfinpyrazone and Tol-Tab (tolbutamide)

MONITOR: The concomitant administration of pyrazolones may increase the hypoglycemic effects of sulfonylureas. Data have been variable. The proposed mechanisms include pyrazolone inhibition of sulfonylurea metabolism, inhibition of renal clearance and/or displacement from protein binding sites.

MANAGEMENT: Patients receiving this combination should be monitored for increased hypoglycemic effects and advised to regularly monitor their blood sugar, counseled on how to recognize and treat hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, tremor, hunger, weakness, or palpitations) and to notify their physician if it occurs. The sulfonylurea dosage may require reduction in affected patients.

References

  1. Petitpierre B, Perrin L, Rudhardt M, et al. (1972) "Behaviour of chlorpropamide in renal insufficiency and under the effect of associated drug therapy." Int J Clin Pharmacol, 6, p. 120-4
  2. Shah SJ, Bhandarkar SD, Satoskar RS (1984) "Drug interaction between chlorpropamide and non-steroidal anti-flammatory drugs, ibuprofen and phenylbutazone." Int J Clin Pharmacol Ther Toxicol, 22, p. 470-2
  3. Yu T, Berger L, Gutman AB (1968) "Hypoglycemic and uricosuric properties of acetohexamide and hydroxyhexamide." Metabolism, 17, p. 309-16
  4. Field JB, Ohta M, Boyle C, Remer A (1967) "Potentiation of acetohexamide hypoglycemia by phenylbutazone." N Engl J Med, 277, p. 889-94
  5. Tannenbaum H, Anderson LG, Soeldner JS (1974) "Phenylbutazone-tolbutamide drug interaction." N Engl J Med, 290, p. 344
  6. Ober KF (1974) "Mechanism of interaction of tolbutamide and phenylbutazone in diabetic patients." Eur J Clin Pharmacol, 7, p. 291-4
  7. Slade IH, and Iosefa RN (1967) "Fatal hypoglycemic coma from the use of tolbutamide in elderly patients: report of two cases." J Am Geriatr Soc, 15, p. 948-50
  8. Pond SM, Birkett DJ, Wade DN (1977) "Mechanisms of inhibition of tolbutamide metabolism: phenylbutazone, oxyphenbutazone, sulfaphenazole." Clin Pharmacol Ther, 22, p. 573-9
  9. Christensen LK, Hansen JM, Kristensen M (1963) "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics." Lancet, 2, p. 1298-301
  10. Hellman B (1974) "Potentiating effects of drugs on the binding of glibenclamide to pancreatic beta cells." Metabolism, 23, p. 839-46
  11. Miners JO, Foenander T, Wanwimolruk S, Gallus AS, Birkett DJ (1982) "The effect of sulphinpyrazone on oxidative drug metabolism in man: inhibition of tolbutamide elimination." Eur J Clin Pharmacol, 22, p. 321-6
  12. Held H, Kaminski B, von Oldersausen HF (1970) "Die beeinflussung der elimination von glycodiazin durch leber- und nierenfunctionssorungen und durch eine behandlung mit phenylbutazone, phenprocumarol und doxycyclin." Diabetologia, 6, p. 386-91
  13. Mahfouz M, Abdel-Maguid R, El-Dakhakhny M (1970) "Potentiation of the hypoglycaemic action of tolbutamide by different drugs." Arzneimittelforschung, 20, p. 120-2
  14. Schultz E, Koch K, Schmidt FH (1971) "Ursachen der potenzierung der hypoglykamischen wirkung von sulfonylharnstoff-derivaten durch medikamente. II. Pharmakokinetik und metabolismus von glibenclamid (HB 419) in gegenwart von phenylbuazon." Eur J Clin Pharmacol, 4, p. 32-7
  15. Eckhardt W, Rudolph R, Sauer H, Schubert WR, Undeutsch D (1972) "Zur pharmakologischen interferenz von glibornurid mit sulfaphenazol, phenylbutazon und phenprocoumon beim menschen." Arzneimittelforschung, 22, p. 2212-9
  16. Held H, Scheible G (1981) "Interaktion von pnenylbutazon und oxyphenbutazon mit glymidin." Arzneimittelforschung, 31, p. 1036-8
  17. Cerner Multum, Inc. "UK Summary of Product Characteristics."
View all 17 references

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Drug and food interactions

Moderate

TOLBUTamide food

Applies to: Tol-Tab (tolbutamide)

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.

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