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Drug Interaction Report

2 potential interactions and/or warnings found for the following 2 drugs:

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Interactions between your drugs

Moderate

hydrocortisone topical insulin inhalation, rapid acting

Applies to: Genasone/Aloe (hydrocortisone topical), Afrezza (insulin inhalation, rapid acting)

MONITOR: The efficacy of insulin and other antidiabetic agents may be diminished by topical corticosteroids in situations where they are absorbed systemically. Corticosteroids can raise blood glucose levels by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Factors that can affect the likelihood of systemic absorption include the steroid's potency and formulation, duration of exposure, application surface area, use on occluded areas of skin, and thickness and/or integrity of skin in the applied areas. Infants and small children also have an increased risk of systemic absorption due to their larger skin surface to body mass ratios. The interaction was suspected in a case report of a 71-year-old patient with type 1 diabetes mellitus that had been well controlled on an insulin pump. The patient developed acute hyperglycemia after using fluocinonide 0.1% cream for 2 days due to a psoriasis flare. He was applying the cream twice daily to a large area of his body (including his abdomen) and using occlusive techniques to increase its effectiveness. His insulin requirements increased from 73 units per day to 326 units in a 24-hour period. The patient's hyperglycemia resolved with discontinuation of the fluocinonide cream, allowing him to resume his previous insulin dosage.

MANAGEMENT: Close clinical monitoring of glycemic control is recommended when systemic absorption of topical corticosteroids is considered probable or likely (e.g., more potent agents, larger areas of application, longer duration of treatment, application on thinner skin like the face, occlusion of the application area, use on infants or young children), with adjustment of the patient's antidiabetic regimen as needed. The package labeling of the corticosteroid involved should be consulted to assess the risk.

References

  1. Seale JP, Compton MR (1986) "Side-effects of corticosteroid agents." Med J Aust, 144, p. 139-42
  2. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R (1993) "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia, 36, p. 84-7
  3. Carruthers JA, Staughton RC, August PJ (1977) "Penetration of topical steroid preparations." Arch Dermatol, 113, p. 522
  4. Pace WE (1973) "Topical corticosteroids." Can Med Assoc J, 108, 11 passim
  5. (2022) "Product Information. Ultravate (halobetasol topical)." Apothecon Inc
  6. (2001) "Product Information. Diprolene (betamethasone topical)." Schering Corporation
  7. "Product Information. Temovate (clobetasol topical)." Glaxo Wellcome
  8. (2001) "Product Information. Psorcon (diflorasone topical)." Rhone Poulenc Rorer
  9. Sue LY, milanesi a (2023) Acute hyperglycemia due to topical corticosteroid administration. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334317/
  10. (2022) "Product Information. Dermovate (clobetasol topical)." GlaxoSmithKline UK Ltd
View all 10 references

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Drug and food interactions

Moderate

insulin inhalation, rapid acting food

Applies to: Afrezza (insulin inhalation, rapid acting)

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 duplication 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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Further information

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