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Interactions between Acebutolol and Soliqua

2 drug interactions and 41 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

acebutolol insulin glargine

Applies to: acebutolol and Soliqua (insulin glargine / lixisenatide)
Monitor

Beta-blockers may inhibit some of the normal physiologic response to hypoglycemia. Symptoms of hypoglycemia such as tremor and tachycardia may be absent, making it more difficult for patients to recognize an oncoming episode. In addition, multiple effects on glucose metabolism have been reported, usually with the noncardioselective beta-blockers (e.g., propranolol, pindolol, timolol) but occasionally also with relatively beta-1 selective agents (e.g., atenolol, metoprolol, nebivolol). Specifically, inhibition of catecholamine-mediated glycogenolysis and glucose mobilization in association with beta-blockade can potentiate insulin-induced hypoglycemia in diabetics and delay the recovery of normal blood glucose levels. Prolonged and severe hypoglycemia may occur, although these events have rarely been reported. Significant increases in blood pressure and bradycardia can also occur during hypoglycemia in diabetics treated with insulin and beta-blockers due to antagonism of epinephrine's effect on beta-2 adrenergic receptors, which leads to unopposed alpha-adrenergic effects including vasoconstriction. On the other hand, decreased glucose tolerance and decreased glucose-induced insulin secretion have also been reported with various beta-blockers. For example, cardioselective beta-blockers like atenolol have been noted to increase insulin resistance while others such metoprolol and the noncardioselective propranolol are known to increase hepatic glycogenolysis and gluconeogenesis, which may contribute to hyperglycemia. However, beta-blockers with intrinsic sympathomimetic activity and alpha-adrenergic activity, such as labetalol and pindolol, or those with alpha-blocking effects, such as carvedilol, are reported to have a lesser impact on insulin sensitivity and may even have neutral or mildly positive effects on glycemic control due to vasodilating and insulin-sensitizing effects. The extent to which these opposing effects manifest clinically and whether one effect will predominate are unclear.

Management

In general, cardioselective beta-blockers are considered safer than noncardioselective agents in the treatment of diabetic patients. Nevertheless, caution is advised if they are prescribed to patients treated with insulin or oral antidiabetic agents that can cause hypoglycemia (e.g., insulin secretagogues), as cardioselectivity is not absolute and larger doses of beta-1 selective agents may pose some of the same risks as nonselective agents. Due to the potential for hypoglycemia and/or hyperglycemia, patients should be advised of the need for regular blood glucose monitoring. They should be made aware that certain symptoms of hypoglycemia such as tremor and tachycardia may be masked. However, other symptoms such as headache, dizziness, drowsiness, confusion, nausea, hunger, weakness, and perspiration may be unaffected. The same precautions are applicable in diabetic patients treated with ophthalmic beta-blockers.

References (19)
  1. Shepherd AM, Lin M-S, Keeton TK (1981) "Hypoglycemia-induced hypertension in a diabetic patient on metoprolol." Ann Intern Med, 94, p. 357-8
  2. Micossi P, Pollavini G, Raggi U, et al. (1984) "Effects of metoprolol and propranolol on glucose tolerance and insulin secretion in diabetes mellitus." Horm Metab Res, 16, p. 59-63
  3. Popp DA, Tse TF, Shah SD, et al. (1984) "Oral propranolol and metoprolol both impair glucose recovery from insulin-induced hypoglycemia in insulin-dependent diabetes mellitus." Diabetes Care, 7, p. 243-7
  4. Mann SJ, Krakoff LR (1984) "Hypertensive crisis caused by hypoglycemia and propranolol." Arch Intern Med, 144, p. 2427-8
  5. Groop L, Totterman KJ, Harno K, Gordin A (1982) "Influence of beta-blocking drugs on glucose metabolism in patients with non-insulin dependent diabetes mellitus." Acta Med Scand, 211, p. 7-12
  6. Viberti GC, Keen H, Bloom SR (1980) "Beta blockade and diabetes mellitus: effect of oxprenolol and metoprolol on the metabolic, cardiovascular, and hormonal response to insulin-induced hypoglycemia in insulin-dependent diabetics." Metabolism, 29, p. 873-9
  7. Viberti GC, Keen H, Bloom SR (1980) "Beta blockade and diabetes mellitus: effect of oxprenolol and metoprolol on the metabolic, cardiovascular, and hormonal response to insulin-induced hypoglycemia in normal subjects." Metabolism, 29, p. 866-72
  8. Newman RJ (1976) "Comparison of propranolol, metoprolol, and acebutolol on insulin-induced hypoglycaemia." Br Med J, 2, p. 447-9
  9. Smith U (1978) "Beta blockade in diabetes." N Engl J Med, 299, p. 1467
  10. Zaman R, Kendall MJ, Biggs PI (1982) "The effect of acebutolol and propranolol on the hypoglycaemic action of glibenclamide." Br J Clin Pharmacol, 13, p. 507-12
  11. Munroe WP, Rindone JP, Kershner RM (1985) "Systemic side effects associated with the ophthalmic administratiion of timolol." Drug Intell Clin Pharm, 19, p. 85-9
  12. Ostman J (1983) "B-adrenergic blockade and diabetes mellitus." Acta Med Scand, 672, p. 69-77
  13. Deacon SP, Karunanayake A, Barnett D (1977) "Acebutolol, atenolol, and propranolol and metabolic responses to acute hypoglycaemia in diabetes." Br Med J, 12, p. 1255-7
  14. Pollare T, Lithell H, Selinus I, Berne C (1989) "Sensitivity to insulin during treatment with atenolol and metoprolol: a randomised, double blind study of effects on carbohydrate and lipoprotein metabolism in hypertensive patients." BMJ, 298, p. 1152-7
  15. Sinclair AJ, Davies IB, Warrington SJ (1990) "Betaxolol and glucose-insulin relationships: studies in normal subjects taking glibenclamide or metformin." Br J Clin Pharmacol, 30, p. 699-702
  16. (1975) "New Zealand Committee on Adverse Drug Reactions. Ninth Annual Report." N Z Dent J, 71, p. 28-32
  17. (2024) "Product Information. Sidapvia 10/100 (dapagliflozin-siTagliptin)." AstraZeneca Pty Ltd, VV-RIM-06210739 v 1.
  18. Sirenko Y, Rekovets O, Torbas O, et al. (2017) "Effect of Beta - Blockers on Insulin Resistance in Patients with Hypertension and Metabolic Syndrome after 6 Months of Treatment" J Endocrinol Diab, 4, p. 1-11
  19. (2026) "Product Information. Awiqli FlexTouch (insulin icodec)." Novo Nordisk Pharmaceuticals Inc
Moderate:

insulin glargine lixisenatide

Applies to: Soliqua (insulin glargine / lixisenatide) and Soliqua (insulin glargine / lixisenatide)
Adjust dose

Coadministration of a glucagon-like peptide-1 (GLP-1) receptor agonist or dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist with insulin may potentiate the risk of hypoglycemia. GLP-1 receptor agonists and dual GLP-1 and GIP receptor agonists lower blood glucose by stimulating insulin secretion and lowering glucagon secretion. An increased incidence of hypoglycemia has been observed in patients treated with a combination of basal insulin and GLP-1 or dual GLP-1 and GIP receptor agonists. Additionally, patients with diabetic retinopathy who received treatment with basal insulin and subcutaneous semaglutide in one clinical trial had an increased risk of developing diabetic retinopathy complications. Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy, but other mechanisms cannot be excluded. The safety and efficacy of GLP-1 or dual GLP-1 and GIP receptor agonists in combination with non-basal insulin have not been established.

Management

When a GLP-1 receptor agonist or dual GLP-1 and GIP receptor agonist is used as add-on therapy to basal insulin, a lower dosage of insulin may be required. Some clinical trials have reduced the basal insulin dose by 20% in patients with a baseline hemoglobin A1c <= 8% when a GLP-1 or dual GLP-1 and GIP receptor agonist was initiated. Because diabetic ketoacidosis has been reported in insulin-dependent patients after rapid discontinuation or dose reduction of insulin, a stepwise approach to insulin dose reduction is recommended and blood glucose levels should be closely monitored. Patients should receive guidance on the recognition and management of hypoglycemia as well as precautions to take to avoid hypoglycemia, particularly while driving or operating hazardous machinery. Those with diabetic retinopathy should also be monitored for progression of the condition or complications. A rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy.

References (16)
  1. (2010) "Product Information. Victoza (liraglutide)." Novo Nordisk Pharmaceuticals Inc
  2. (2014) "Product Information. Tanzeum (albiglutide)." GlaxoSmithKline
  3. (2014) "Product Information. Trulicity (dulaglutide)." Eli Lilly and Company
  4. (2016) "Product Information. Adlyxin (lixisenatide)." sanofi-aventis
  5. (2022) "Product Information. Ozempic (1 mg dose) (semaglutide)." Novo Nordisk Pharmaceuticals Inc
  6. (2022) "Product Information. Mounjaro (tirzepatide)." Lilly, Eli and Company
  7. (2022) "Product Information. Wegovy (2.4 mg dose) (semaglutide)." Novo Nordisk Pharmaceuticals Inc, SUPPL-3
  8. (2023) "Product Information. Bydureon BCise (exenatide)." AstraZeneca UK Ltd
  9. (2022) "Product Information. Byetta Prefilled Pen (exenatide)." Astra-Zeneca Pharmaceuticals
  10. (2014) "Product Information. Eperzan (albiglutide)." GlaxoSmithKline UK Ltd
  11. (2023) "Product Information. Trulicity (dulaglutide)." Eli Lilly and Company Ltd
  12. (2022) "Product Information. Saxenda (liraglutide)." Novo Nordisk Ltd
  13. (2022) "Product Information. Victoza (liraglutide)." Novo Nordisk Ltd
  14. (2022) "Product Information. Lyxumia (lixisenatide)." Sanofi
  15. (2023) "Product Information. Ozempic (semaglutide)." Novo Nordisk Ltd
  16. (2026) "Product Information. Awiqli FlexTouch (insulin icodec)." Novo Nordisk Pharmaceuticals Inc

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

insulin glargine Food/Lifestyle

Applies to: Soliqua (insulin glargine / lixisenatide)
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 (11)
  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."
  11. (2026) "Product Information. Awiqli FlexTouch (insulin icodec)." Novo Nordisk Pharmaceuticals Inc
Moderate:

lixisenatide Food/Lifestyle

Applies to: Soliqua (insulin glargine / lixisenatide)
Adjust dosing interval

Lixisenatide slows gastric emptying, which may impact the absorption of concomitantly administered oral medications. The interaction has been studied with various medications, which demonstrated primarily an effect on the rate rather than the overall extent of absorption. Acetaminophen: When acetaminophen 1000 mg was administered 1 hour and 4 hours after lixisenatide 10 mcg injection, acetaminophen peak plasma concentration (Cmax) was decreased by 29% and 31%, respectively; and median time to peak plasma concentration (Tmax) was delayed by 2 hours and 1.75 hours, respectively. The Cmax and Tmax of acetaminophen were not significantly altered when acetaminophen was given one hour before lixisenatide injection, and systemic exposure (AUC) was not affected whether administered before or after lixisenatide administration. Based on these results, no dose adjustment for acetaminophen is required; however, it may be advisable to take acetaminophen at least one hour before lixisenatide if a rapid onset of action is required. Oral Contraceptives: When an oral contraceptive containing ethinyl estradiol 0.03 mg and levonorgestrel 0.15 mg was administered 1 hour and 4 hours after lixisenatide 10 mcg injection, ethinyl estradiol Cmax was decreased by 52% and 39%, respectively, while levonorgestrel Cmax was decreased by 46% and 20%, respectively. Median Tmax values were delayed by 1 to 3 hours, but overall exposure (AUC) and mean terminal half-life (T1/2) of ethinyl estradiol and levonorgestrel were not significantly altered. Administration of the oral contraceptive 1 hour before or 11 hours after lixisenatide had no effect on any of the measured pharmacokinetic parameters of either ethinyl estradiol or levonorgestrel. Based on these results, no dose adjustment for oral contraceptives is required; however, some authorities recommend that oral contraceptives be administered at least 1 hour before or 11 hours after lixisenatide. Atorvastatin: When atorvastatin 40 mg and lixisenatide 20 mcg were coadministered in the morning for 6 days, atorvastatin Cmax was decreased by 31% and Tmax was delayed by 3.25 hours, but AUC was not affected. When atorvastatin was administered in the evening and lixisenatide in the morning, the AUC and Cmax of atorvastatin were increased by 27% and 66%, respectively, but there was no change in Tmax. Based on these results, no dose adjustment for atorvastatin is required; however, some authorities recommend that atorvastatin be administered at least 1 hour before lixisenatide. Warfarin: When warfarin 25 mg was coadministered with repeated dosing of lixisenatide 20 mcg, warfarin Cmax was decreased by 19% and Tmax was delayed by 7 hours, but there were no effects on AUC or International Normalized Ratio (INR). Based on these results, no dose adjustment for warfarin is required; however, closer monitoring of INR may be appropriate following initiation or discontinuation of lixisenatide treatment. Digoxin: When digoxin 0.25 mg and lixisenatide 20 mcg were coadministered at steady state, digoxin Cmax was decreased by 26% and Tmax was delayed by 1.5 hours, but AUC was not affected. Based on these results, no dose adjustment for digoxin is required. Ramipril: When ramipril 5 mg and lixisenatide 20 mcg were coadministered for 6 days, ramipril Cmax was decreased by 63% and AUC was increased by 21%, while Cmax and AUC of the active metabolite (ramiprilat) were not affected. The Tmax values of ramipril and ramiprilat were delayed by approximately 2.5 hours. Based on these results, no dose adjustment for ramipril is required.

Management

Caution is advised during concomitant use of lixisenatide with oral medications that have a narrow therapeutic index or that require careful clinical monitoring. These medications should be administered on a consistent schedule relative to lixisenatide, and blood levels and/or pharmacologic effects should be closely monitored. In addition, if they are to be administered with food, patients should be advised to take them with a meal or snack when lixisenatide is not administered. Oral medications that are particularly dependent on threshold concentrations for efficacy, such as antibiotics, or medications for which a delay in effect is undesirable, such as acetaminophen, should be administered at least 1 hour before lixisenatide. Gastro-resistant formulations containing substances sensitive to stomach degradation should be administered 1 hour before or 4 hours after lixisenatide. Patients taking oral contraceptives should be advised to take them at least 1 hour before or 11 hours after lixisenatide.

References (1)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
Moderate:

acebutolol Alcohol (Ethanol)

Applies to: acebutolol
Monitor

Certain psychotherapeutic and other CNS-active agents may have blood pressure-lowering effects and may cause dizziness, orthostatic hypotension, or syncope. These effects may be more likely during treatment initiation, dose escalation, or treatment restart. Coadministration with antihypertensives or other agents with blood pressure-lowering properties, particularly vasodilators and alpha-adrenergic blockers, may result in additive hypotensive or orthostatic effects.

Management

Monitor blood pressure and clinical response during concomitant use, especially when starting or increasing the dose of either agent. Patients should be advised to rise slowly from a sitting or lying position and to report dizziness, lightheadedness, fainting, orthostasis, palpitations, or troublesome changes in pulse or heart rate. Patients should be cautioned that alcohol may enhance blood pressure-lowering effects during concomitant use with antihypertensives or other agents with hypotensive properties. Patients should avoid driving or operating hazardous machinery until they know how the medications affect them.

References (13)
  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  7. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
  8. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  9. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd
  10. (2026) "Product Information. Urapidil (Carinopharm) (urapidil)." Imported (EU)
  11. (2020) "Product Information. URAPIDIL ACCORD (urapidil)." ACCORD HEALTHCARE LIMITED
  12. (2020) "Product Information. Ebrantil (urapidil)." CHEPLAPHARM ARZNEIMITTEL GMBH
  13. (2026) "Product Information. Urapidil (urapidil)." Imported (Switzerland)
Moderate:

acebutolol multivitamins with minerals

Applies to: acebutolol
Adjust dosing interval

Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

Management

It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References (1)
  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

Disease interactions

37 potential interactions Applies to: 34 conditions, including High Cholesterol, Allergies, Heart Failure, Asthma, and COPD.

Adrenal Insufficiency

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Adrenal Insufficiency.

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.

Alcoholism

Major:

Soliqua

The lixisenatide in Soliqua has a major potential interaction with Alcoholism.

Acute pancreatitis, including fatal and non- fatal hemorrhagic or necrotizing pancreatitis, has been reported postmarketing in patients treated with lixisenatide. Some patients had risk factors such as cholelithiasis and alcohol abuse. Patients should be observed carefully for any symptoms of pancreatitis including persistent abdominal pain, sometimes radiating to the back, that may or may not be accompanied by vomiting. If pancreatitis is suspected, lixisenatide should be discontinued and appropriate management should be established. If pancreatitis is confirmed, lixisenatide should not be restarted. Lixisenatide is not recommended for patients with history of pancreatitis.

Allergies

Major:

acebutolol

Acebutolol has a major potential interaction with Allergies.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

Anaphylaxis

Major:

Soliqua

The lixisenatide in Soliqua has a major potential interaction with Anaphylaxis.

The use of lixisenatide may result in cross-sensitivity in patients with a history of anaphylaxis reaction or angioedema to another GLP-1 receptor agonist. These patients should be informed of the risk of anaphylaxis when using lixisenatide. Close monitoring is recommended when prescribing lixisenatide to these patients.

Angioedema

Major:

Soliqua

The lixisenatide in Soliqua has a major potential interaction with Angioedema.

The use of lixisenatide may result in cross-sensitivity in patients with a history of anaphylaxis reaction or angioedema to another GLP-1 receptor agonist. These patients should be informed of the risk of anaphylaxis when using lixisenatide. Close monitoring is recommended when prescribing lixisenatide to these patients.

Anorexia/Feeding Problems

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with 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.

Asthma

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Asthma.

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

Autonomic Neuropathy

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Autonomic Neuropathy.

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.

Cardiogenic Shock

Major:

acebutolol

Acebutolol has a major potential interaction with Cardiogenic Shock.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

Cerebrovascular Insufficiency

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Cerebrovascular Insufficiency.

Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

COPD

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with COPD.

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

Diabetes Mellitus

Major:

acebutolol

Acebutolol has a major potential interaction with Diabetes Mellitus.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

Gallstones

Major:

Soliqua

The lixisenatide in Soliqua has a major potential interaction with Gallstones.

Acute pancreatitis, including fatal and non- fatal hemorrhagic or necrotizing pancreatitis, has been reported postmarketing in patients treated with lixisenatide. Some patients had risk factors such as cholelithiasis and alcohol abuse. Patients should be observed carefully for any symptoms of pancreatitis including persistent abdominal pain, sometimes radiating to the back, that may or may not be accompanied by vomiting. If pancreatitis is suspected, lixisenatide should be discontinued and appropriate management should be established. If pancreatitis is confirmed, lixisenatide should not be restarted. Lixisenatide is not recommended for patients with history of pancreatitis.

Gastroparesis

Major:

Soliqua

The lixisenatide in Soliqua has a major potential interaction with Gastroparesis.

Lixisenatide slows gastric emptying and patients with preexisting gastroparesis were excluded from clinical trials. Lixisenatide should not be used in patients with severe gastroparesis.

Glaucoma/Intraocular Hypertension

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

Heart Block

Major:

acebutolol

Acebutolol has a major potential interaction with Heart Block.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

Heart Failure

Major:

acebutolol

Acebutolol has a major potential interaction with Heart Failure.

Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

Hemodialysis

Major:

acebutolol

Acebutolol has a major potential interaction with Hemodialysis.

Acebutolol is moderately removed by hemodialysis and should be administered after dialysis when the patient is hemodynamically stable to avoid marked falls in blood pressure. The hemodynamic status should be closely monitored before and after the dose.

High Cholesterol

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with High Cholesterol.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

Hyperthyroidism

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Hyperthyroidism.

When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

Hypokalemia

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Hypokalemia.

Hypokalemia may commonly occur during treatment with insulin. Use with caution in patients who may be particularly at risk of developing hypokalemia (e.g., patients using potassium-lowering medications, patients taking medications sensitive to serum potassium concentrations).

Hypotension

Major:

acebutolol

Acebutolol has a major potential interaction with Hypotension.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

Ischemic Heart Disease

Major:

acebutolol

Acebutolol has a major potential interaction with Ischemic Heart Disease.

Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

Liver Disease

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Liver Disease.

Acebutolol should be used cautiously in patients with impaired hepatic function.

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Liver Disease.

Insulin requirements may be diminished in patients with renal or hepatic impairment due to reduced insulin metabolism and, in the latter case, also to reduced capacity for gluconeogenesis. Lower initial dosages may be appropriate, with careful monitoring of plasma glucose levels and dosing adjustments.

Malnourishment

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Malnourishment.

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.

Myasthenia Gravis

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Myasthenia Gravis.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

Pancreatitis

Major:

Soliqua

The lixisenatide in Soliqua has a major potential interaction with Pancreatitis.

Acute pancreatitis, including fatal and non- fatal hemorrhagic or necrotizing pancreatitis, has been reported postmarketing in patients treated with lixisenatide. Some patients had risk factors such as cholelithiasis and alcohol abuse. Patients should be observed carefully for any symptoms of pancreatitis including persistent abdominal pain, sometimes radiating to the back, that may or may not be accompanied by vomiting. If pancreatitis is suspected, lixisenatide should be discontinued and appropriate management should be established. If pancreatitis is confirmed, lixisenatide should not be restarted. Lixisenatide is not recommended for patients with history of pancreatitis.

Panhypopituitarism

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Panhypopituitarism.

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.

Peripheral Arterial Disease

Major:

acebutolol

Acebutolol has a major potential interaction with Peripheral Arterial Disease.

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

Pheochromocytoma

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Pheochromocytoma.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta receptor-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

Psoriasis

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Psoriasis.

The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

Renal Dysfunction

Major:

acebutolol

Acebutolol has a major potential interaction with Renal Dysfunction.

The active metabolite of acebutolol, diacetolol, is eliminated primarily by the kidney. Patients with renal impairment may be at greater risk for adverse effects due to metabolite accumulation. Dosage adjustments are recommended for patients with moderate to severe renal dysfunction (CrCl < 50 mL/min).

Moderate:

Soliqua

The insulin glargine in Soliqua has a moderate potential interaction with Renal Dysfunction.

Insulin requirements may be diminished in patients with renal or hepatic impairment due to reduced insulin metabolism and, in the latter case, also to reduced capacity for gluconeogenesis. Lower initial dosages may be appropriate, with careful monitoring of plasma glucose levels and dosing adjustments.

Moderate:

Soliqua

The lixisenatide in Soliqua has a moderate potential interaction with Renal Dysfunction.

Acute kidney injury and worsening of chronic renal failure which sometimes required hemodialysis has been reported postmarketing in patients treated with lixisenatide. Renal function should be closely monitored when initiating or escalating doses. Lixisenatide is not recommended for patients with end stage renal disease. Patients with mild and moderate renal impairment need close monitoring but no dose adjustment. There is limited experience in patients with severe renal impairment but drug exposure showed to be higher, so close monitoring is recommended for changes in renal function or gastrointestinal adverse reactions.

Sinus Node Dysfunction

Major:

acebutolol

Acebutolol has a major potential interaction with Sinus Node Dysfunction.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

Tachyarrhythmia

Moderate:

acebutolol

Acebutolol has a moderate potential interaction with Tachyarrhythmia.

Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.

More resources

acebutolol

A total of 512 drugs are known to interact with acebutolol.

Soliqua

A total of 479 drugs are known to interact with Soliqua.

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.