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Tol-Tab (tolbutamide) Disease Interactions

There are 6 disease interactions with Tol-Tab (tolbutamide):

Major

Oral hypoglycemic agents (applies to Tol-Tab) cardiovascular risk

Major Potential Hazard, Moderate plausibility. Applicable conditions: Cardiovascular Disease

The use of oral hypoglycemic agents may be associated with an increased risk of cardiovascular mortality compared to treatment with diet alone or diet with insulin. This warning is based on the University Group Diabetes Program (UGDP) study, a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. Patients treated with diet plus a fixed dosage of either tolbutamide (a sulfonylurea) or phenformin (a biguanide) for 5 to 8 years had a cardiovascular mortality rate approximately 2.5 times that of patients treated with diet alone, resulting in discontinuation of both these treatments in the study. Despite controversy regarding interpretation of these results, clinicians and patients should be aware of the potential risk when making treatment decisions for diabetes, particularly in the presence of underlying cardiovascular disease. Data are not available for other sulfonylureas or biguanides, nor for hypoglycemic agents belonging to other classes. However, given the similarities in chemical structure and/or mode of action, the same caution should be applied.

References

  1. "Product Information. Glucotrol (glipizide)." Pfizer US Pharmaceuticals, New York, NY.
  2. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc, Princeton, NJ.
  3. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. "Product Information. Amaryl (glimepiride)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  5. "Product Information. Dymelor (acetohexamide)" Lilly, Eli and Company, Indianapolis, IN.
  6. "Product Information. Tolinase (tolazamide)" Pharmacia and Upjohn, Kalamazoo, MI.
  7. "Product Information. Glucophage (metformin)." Bristol-Myers Squibb, Princeton, NJ.
  8. "Product Information. Diabinese (chlorpropamide)." Pfizer US Pharmaceuticals, New York, NY.
View all 8 references
Major

Sulfonylureas (applies to Tol-Tab) DKA

Major Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Type 1, Diabetic Ketoacidosis

The use of some sulfonylurea agents is contraindicated for the treatment of patients with diabetic ketoacidosis, with or without coma. In addition, these agents should not be used as sole therapy in patients with type I diabetes mellitus.

Major

Tolbutamide (applies to Tol-Tab) renal/liver disease

Major Potential Hazard, High plausibility. Applicable conditions: Renal Dysfunction

Serious and prolonged hypoglycemia has been reported in patients with severe renal or liver disease following oral administration of tolbutamide. Diagnostic testing with tolbutamide should be administered cautiously, if necessary, in such patients. If severe hypoglycemic symptoms are observed, the test should be terminated immediately by intravenously injecting 12.5 to 25 g of glucose in a 25% to 50% solution. The patient should be monitored for some time afterwards, since reaction may be prolonged.

References

  1. "Product Information. Orinase (tolbutamide)" Pharmacia and Upjohn, Kalamazoo, MI.
Moderate

Insulin/oral hypoglycemic agents (applies to Tol-Tab) hypoglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Adrenal Insufficiency, Malnourished, Autonomic Neuropathy, Panhypopituitarism, Anorexia/Feeding Problems

Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including those who are debilitated or malnourished, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those receiving beta-adrenergic blocking agents.

References

  1. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  2. "Product Information. Glucotrol (glipizide)." Pfizer US Pharmaceuticals, New York, NY.
  3. "Product Information. Novolog (insulin aspart)" Novo Nordisk Pharmaceuticals Inc, Princeton, NJ.
  4. "Product Information. Glucophage (metformin)." Bristol-Myers Squibb, Princeton, NJ.
  5. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc, Princeton, NJ.
  6. "Product Information. Humulin BR (insulin)." Lilly, Eli and Company, Indianapolis, IN.
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. "Product Information. Starlix (nateglinide)" Novartis Pharmaceuticals, East Hanover, NJ.
  9. "Product Information. Dymelor (acetohexamide)" Lilly, Eli and Company, Indianapolis, IN.
  10. "Product Information. Amaryl (glimepiride)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  11. "Multum Information Services, Inc. Expert Review Panel"
  12. "Product Information. Diabinese (chlorpropamide)." Pfizer US Pharmaceuticals, New York, NY.
  13. "Product Information. Lantus (insulin glargine)" Aventis Pharmaceuticals, Swiftwater, PA.
  14. "Product Information. Tolinase (tolazamide)" Pharmacia and Upjohn, Kalamazoo, MI.
  15. "Product Information. Micronase (glyburide)." Pharmacia and Upjohn, Kalamazoo, MI.
View all 15 references
Moderate

Sulfonylureas (applies to Tol-Tab) G6PD deficiency

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: G-6-PD Deficiency

Sulfonylureas can cause hemolytic anemia in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency. Therapy with these agents should be used with caution in patients with G6PD deficiency and consider the use of a non-sulfonylurea alternative. There have been postmarketing reports of hemolytic anemia in patients receiving these drugs who did not have known G6PD deficiency.

Moderate

Sulfonylureas (applies to Tol-Tab) hyponatremia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: SIADH, Dehydration

Treatment with sulfonylureas may cause hyponatremia, in patients who are on other medications or have medical conditions known to cause hyponatremia or increase release of antidiuretic hormone. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported with certain sulfonylureas and these drugs may augment the peripheral (antidiuretic) action of ADH and/or increase release of ADH. Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

Tol-Tab (tolbutamide) drug interactions

There are 463 drug interactions with Tol-Tab (tolbutamide)

Tol-Tab (tolbutamide) alcohol/food interactions

There is 1 alcohol/food interaction with Tol-Tab (tolbutamide)

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.