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Drug Interactions between aspirin / chlorpheniramine / dextromethorphan / phenylephrine and glimepiride

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

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Moderate

aspirin glimepiride

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine and glimepiride

MONITOR: The hypoglycemic effect of insulin secretagogues (e.g., sulfonylureas, meglitinides) may be potentiated by certain drugs, including ACE inhibitors, 4-aminoquinolines, amylin analogs, anabolic steroids, fibrates, monoamine oxidase inhibitors (MAOIs, including linezolid), nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, selective serotonin reuptake inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinine, quinidine, and ginseng. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, fibrates, ginseng); stimulating insulin secretion (salicylates, NSAIDs, disopyramide, quinine, quinidine, MAOIs, ginseng); decreasing insulin clearance and resistance (4-aminoquinolines); increasing peripheral glucose utilization (SSRIs, insulin-like growth factor); inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor); slowing the rate of gastric emptying (amylin analogs); and/or suppressing postprandial glucagon secretion (amylin analogs). Or, they may increase plasma concentration of insulin secretagogues by displacing them from plasma protein binding sites and/or inhibiting their metabolism (fibrates, NSAIDs, salicylates, sulfonamides). Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or sulfonylureas. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases.

MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin secretagogues, particularly in patients with advanced age and/or renal impairment. The oral antidiabetic dosage(s) may require adjustment if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their doctor if it occurs. Patients should be observed for loss of glycemic control when these drugs are withdrawn.

References

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  47. (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
  48. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  49. (2002) "Product Information. Micronase (glyburide)." Pharmacia and Upjohn
  50. Turtle JR, Burgess JA (1973) "Hypoglycemic action of fenfluramine in diabetes mellitus." Diabetes, 22, p. 858-67
  51. Ferriere M, Lachkar H, Richard JL, Bringer J, Orsetti A, Mirouze J (1985) "Captopril and insulin sensitivity." Ann Intern Med, 102, p. 134-5
  52. Johnson JA, Kappel JE, Sharif MN (1993) "Hypoglycemia secondary to trimethoprim/sulfamethoxazole administration in a renal transplant patient." Ann Pharmacother, 27, p. 304-6
  53. Almirall J, Montoliu J, Torras A, Revert L (1989) "Propoxyphene-induced hypoglycemia in a patient with chronic renal failure." Nephron, 53, p. 273-5
  54. Hayashi S, Horie M, Tsuura Y, Ishida H, Okada Y, Seino Y, Sasayama S (1993) "Disopyramide blocks pancreatic ATP-sensitive K+ channels and enhances insulin release." Am J Physiol, 265, c337-42
  55. Phillips AF, Matty PJ, Porte PJ, Raye JR (1984) "Inhibition of glucose-induced insulin secretion by indomethacin and sodium salicylate in the fetal lamb." Am J Obstet Gynecol, 148, p. 481-7
  56. Baron SH (1982) "Salicylates as hypoglycemic agents." Diabetes Care, 5, p. 64-71
  57. Prince RL, Larkins RG, Alford FP (1981) "The effect of acetylsalicylic acid on plasma glucose and the response of glucose regulatory hormones to intravenous glucose and arginine in insulin treated diabetics and normal subjects." Metabolism, 30, p. 293-8
  58. Ferrari C, Fressati S, Romussi M, et al. (1977) "Effects of short-term clofibrate administration on glucose tolerance and insulin secretion in patients with chemical diabetes or hypertriglyceridemia." Metabolism, 26, p. 129-39
  59. Storlien LH, Thorburn AW, Smythe GA, Jenkins AB, Chisholm DJ, Kraegen EW (1989) "Effect of d-fenfluramine on basal glucose turnover and fat-feeding-induced insulin resistance in rats." Diabetes, 38, p. 499-503
  60. Pestell RG, Crock PA, Ward GM, Alford FP, Best JD (1989) "Fenfluramine increases insulin action in patients with NIDDM." Diabetes Care, 12, p. 252-8
  61. Harrison LC, King-Roach A, Martin FI, Melick RA (1975) "The effect of fenfluramine on insulin binding and on basal and insulin-stimulated oxidation of 1-C-glucose by human adipose tissue." Postgrad Med J, 51 Suppl 1, p. 110-4
  62. Feldman JM, Chapman B (1975) "Monoamine oxidase inhibitors: nature of their interaction with rabbit pancreatic islets to alter insulin secretion." Diabetologia, 11, p. 487-94
  63. Aleyassine H, Gardiner RJ (1975) "Dual action of antidepressant drugs (MAO inhibitors) on insulin release." Endocrinology, 96, p. 702-10
  64. Aleyassine H, Lee SH (1972) "Inhibition of insulin release by substrates and inhibitors of monoamine oxidase." Am J Physiol, 222, p. 565-9
  65. Cooper AJ, Ashcroft G (1966) "Potentiation of insulin hypoglycaemia by M.A.O.I. antidepressant drugs." Lancet, 1, p. 407-9
  66. Lozada A, Dujovne CA (1994) "Drug interactions with fibric acids." Pharmacol Ther, 63, p. 163-76
  67. Kradjan WA, Witt DM, Opheim KE, Wood FC (1994) "Lack of interaction between glipizide and co-trimoxazole." J Clin Pharmacol, 34, p. 997-1002
  68. Herings RMC, Deboer A, Stricker BHC, Leufkens HGM, Porsius A (1995) "Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme." Lancet, 345, p. 1195-8
  69. Ahmad S (1995) "Drug interaction induces hypoglycemia." J Fam Pract, 40, p. 540-1
  70. Feher MD, Amiel S (1995) "ACE inhibitors and hypoglycaemia." Lancet, 346, p. 125-6
  71. Paolisso G, Balbi V, Gambardella A, Varricchio G, Tortoriello R, Saccomanno F, Amato L, Varricchio M (1995) "Lisinopril administration improves insulin action in aged patients with hypertension." J Hum Hypertens, 9, p. 541-6
  72. Darcy PF, Griffin JP (1995) "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev, 14, p. 211-31
  73. Kubacka RT, Antla EJ, Juhl RP, Welshman IR (1996) "Effects of aspirin and ibuprofen on the pharmacokinetics and pharmacodynamics of glyburide in healthy subjects." Ann Pharmacother, 30, p. 20-6
  74. (2001) "Product Information. Amaryl (glimepiride)." Hoechst Marion Roussel
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  78. Morrison PJ, Rogers HJ, Spector RG, Bradbrook ID, John VA (1982) "Effect of pirprofen on glibenclamide kinetics and response." Br J Clin Pharmacol, 14, p. 123-6
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  81. Iida H, Morita T, Suzuki E, Iwasawa K, Toyooka T, Nakajima T (1999) "Hypoglycemia induced by interaction between clarithromycin and disopyramide." Jpn Heart J, 40, p. 91-6
  82. Morris AD, Newton RW, Boyle DI, et al. (1997) "ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes." Diabetes Care, 20, p. 1363-7
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  87. Niemi M, Backman JT, Neuvonen M, Laitila J, Neuvonen PJ, Kivisto KT (2001) "Effects of fluconazole and fluvoxamine on the pharmacokinetics and pharmacodynamics of glimepiride." Clin Pharmacol Ther, 69, p. 194-200
  88. Abad S, Moachon L, Blanche P, Bavoux F, Sicard D, Salmon-Ceron D (2001) "Possible interaction between glicazide, fluconazole and sulfamethoxazole resulting in severe hypoglycaemia." Br J Clin Pharmacol, 52, p. 456-7
  89. Pollak PT, Mukherjee SD, Fraser AD (2001) "Sertraline-induced hypoglycemia." Ann Pharmacother, 35, p. 1371-4
  90. Tran PO, Gleason CE, Robertson RP (2002) "Inhibition of interleukin-1beta-induced COX-2 and EP3 gene expression by sodium salicylate enhances pancreatic islet beta-cell function." Diabetes, 51, p. 1772-8
  91. Hundal RS, Petersen KF, Mayerson AB, et al. (2002) "Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes." J Clin Invest, 109, p. 1321-6
  92. Tremaine LM, Wilner KD, Preskorn SH (1997) "A study of the potential effect of sertraline on the pharmacokinetics and protein binding of tolbutamide." Clin Pharmacokinet, 32(Suppl 1), p. 31-36
  93. (2004) "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals
  94. Fogari R, Zoppi A, Corradi L, Pierangelo L, Mugellini A, Lusardi P (1998) "Comparative effects of lisinopril and losartan on insulin sensitivity in the treatment of non diabetic hypertension." Br J Clin Pharmacol, 46, p. 467-71
  95. Sone H, Takahashi A, Yamada N (2001) "Ibuprofen-related hypoglycemia in a patient receiving sulfonylurea." Ann Intern Med, 134, p. 344
  96. Sawka AM, Burgart V, Zimmerman D (2001) "Loss of awareness of hypoglycemia temporally associated with selective serotonin reuptake inhibitors." Diabetes Care, 24, p. 1845-6
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  98. Vuksan V, Sievenpiper JL, Koo VY, et al. (2000) "American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus." Arch Intern Med, 160, p. 1009-13
  99. Vuksan V, Stavro MP, Sievenpiper JL, et al. (2000) "Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes." Diabetes Care, 23, p. 1221-6
  100. Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V (2003) "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L.) with a depressed ginsenoside profile does not affect postprandial glycemia." Eur J Clin Nutr, 57, p. 243-8
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Moderate

chlorpheniramine dextromethorphan

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine and aspirin / chlorpheniramine / dextromethorphan / phenylephrine

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients. Sedation and impairment of attention, judgment, thinking, and psychomotor skills may increase.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Cautious dosage titration may be required, particularly at treatment initiation. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

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  2. Stambaugh JE, Lane C (1983) "Analgesic efficacy and pharmacokinetic evaluation of meperidine and hydroxyzine, alone and in combination." Cancer Invest, 1, p. 111-7
  3. Sotaniemi EA, Anttila M, Rautio A, et al. (1981) "Propranolol and sotalol metabolism after a drinking party." Clin Pharmacol Ther, 29, p. 705-10
  4. Grabowski BS, Cady WJ, Young WW, Emery JF (1980) "Effects of acute alcohol administration on propranolol absorption." Int J Clin Pharmacol Ther Toxicol, 18, p. 317-9
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  11. Feldman SA, Crawley BE (1970) "Interaction of diazepam with the muscle-relaxant drugs." Br Med J, 1, p. 336-8
  12. Ochs HR, Greenblatt DJ, Verburg-Ochs B (1984) "Propranolol interactions with diazepam, lorazepam and alprazolam." Clin Pharmacol Ther, 36, p. 451-5
  13. Desager JP, Hulhoven R, Harvengt C, Hermann P, Guillet P, Thiercelin JF (1988) "Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic." Psychopharmacology (Berl), 96, p. 63-6
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  17. Greb WH, Buscher G, Dierdorf HD, Koster FE, Wolf D, Mellows G (1989) "The effect of liver enzyme inhibition by cimetidine and enzyme induction by phenobarbitone on the pharmacokinetics of paroxetine." Acta Psychiatr Scand, 80 Suppl, p. 95-8
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  22. (2001) "Product Information. Seroquel (quetiapine)." Astra-Zeneca Pharmaceuticals
  23. (2001) "Product Information. Meridia (sibutramine)." Knoll Pharmaceutical Company
  24. (2001) "Product Information. Tasmar (tolcapone)." Valeant Pharmaceuticals
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  34. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
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  36. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
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Moderate

phenylephrine glimepiride

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine and glimepiride

MONITOR: The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics, estrogens, gonadotropin-releasing hormone agonists, human growth hormone, phenothiazines, progestins, protease inhibitors, sympathomimetic amines, thyroid hormones, L-asparaginase, alpelisib, copanlisib, danazol, diazoxide, isoniazid, megestrol, omacetaxine, phenytoin, sirolimus, tagraxofusp, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.

MANAGEMENT: Caution is advised when drugs that can interfere with glucose metabolism are prescribed to patients with diabetes. Close clinical monitoring of glycemic control is recommended following initiation or discontinuation of these drugs, and the dosages of concomitant antidiabetic agents adjusted as necessary. Patients should be advised to notify their physician if their blood glucose is consistently high or if they experience symptoms of severe hyperglycemia such as excessive thirst and increases in the volume or frequency of urination. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen.

References

  1. Greenstone MA, Shaw AB (1987) "Alternate day corticosteroid causes alternate day hyperglycaemia." Postgrad Med J, 63, p. 761-4
  2. Pollare T, Lithell H, Berne C (1989) "A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension." N Engl J Med, 321, p. 868-73
  3. Carter BL, Small RE, Mandel MD, Starkman MT (1981) "Phenytoin-induced hyperglycemia." Am J Hosp Pharm, 38, p. 1508-12
  4. Al-Rubeaan K, Ryan EA (1991) "Phenytoin-induced insulin insensitivity." Diabet Med, 8, p. 968-70
  5. Chaudhuri ML, Catania J (1988) "A comparison of the effects of bumetanide (Burinex) and frusemide on carbohydrate metabolism in the elderly." Br J Clin Pract, 42, p. 427-9
  6. Goldman JA, Neri A, Ovadia J, Eckerling B, Vries A, de (1969) "Effect of chlorothiazide on intravenous glucose tolerance in pregnancy." Am J Obstet Gynecol, 105, p. 556-60
  7. Miller NR, Moses H (1978) "Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance." JAMA, 240, p. 1887-8
  8. Kansal PC, Buse J, Buse MG (1969) "Thiazide diuretics and control of diabetes mellitus." South Med J, 62, p. 1372-9
  9. Andersen OO, Persson I (1968) "Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid." Br Med J, 2, p. 798-801
  10. Curtis J, Horrigan F, Ahearn D, Varney R, Sandler SG (1972) "Chlorthalidone-induced hyperosmolar hyperglycemic nonketotic coma." JAMA, 220, p. 1592-3
  11. Chowdhury FR, Bleicher SJ (1970) "Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism." Horm Metab Res, 2, p. 13-6
  12. Diamond MT (1972) "Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis." N Y State J Med, 72, p. 1741-2
  13. Jones IG, Pickens PT (1967) "Diabetes mellitus following oral diuretics." Practitioner, 199, p. 209-10
  14. Black DM, Filak AT (1989) "Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection." J Fam Pract, 28, p. 462-3
  15. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG (1980) "Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient?" Scand J Urol Nephrol Suppl, 54, p. 135-8
  16. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT (1982) "Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up." Lancet, 2, p. 1293-5
  17. Seltzer HS, Allen EW (1969) "Hyperglycemia and inhibition of insulin secretion during administration of diazoxide and trichlormethiazide in man." Diabetes, 18, p. 19-28
  18. Jori A, Carrara MC (1966) "On the mechanism of the hyperglycaemic effect of chlorpromazine." J Pharm Pharmacol, 18, p. 623-4
  19. Erle G, Basso M, Federspil G, Sicolo N, Scandellari C (1977) "Effect of chlorpromazine on blood glucose and plasma insulin in man." Eur J Clin Pharmacol, 11, p. 15-8
  20. (2002) "Product Information. Thorazine (chlorpromazine)." SmithKline Beecham
  21. (2002) "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals
  22. (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
  23. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  24. (2002) "Product Information. Synthroid (levothyroxine)." Abbott Pharmaceutical
  25. (2001) "Product Information. Carafate (sucralfate)." Hoechst Marion Roussel
  26. Stambaugh JE, Tucker DC (1974) "Effect of diphenylhydantoin on glucose tolerance in patients with hypoglycemia." Diabetes, 23, p. 679-83
  27. Malherbe C, Burrill KC, Levin SR, Karam JH, Forsham PH (1972) "Effect of diphenylhydantoin on insulin secretion in man." N Engl J Med, 286, p. 339-42
  28. Javier Z, Gershberg H, Hulse M (1968) "Ovulatory suppressants, estrogens, and carbohydrate metabolism." Metabolism, 17, p. 443-56
  29. Sotaniemi E, Kontturi M, Larmi T (1973) "Effect of diethylstilbestrol on blood glucose of prostatic cancer patients." Invest Urol, 10, p. 438-41
  30. Bell DS (1993) "Insulin resistance. An often unrecognized problem accompanying chronic medical disorders." Postgrad Med, 93, 99-103,
  31. Berlin I (1993) "Prazosin, diuretics, and glucose intolerance." Ann Intern Med, 119, p. 860
  32. Rowe P, Mather H (1985) "Hyperosmolar non-ketotic diabetes mellitus associated with metolazone." Br Med J, 291, p. 25-6
  33. Haiba NA, el-Habashy MA, Said SA, Darwish EA, Abdel-Sayed WS, Nayel SE (1989) "Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters." Contraception, 39, p. 619-32
  34. Virutamasen P, Wongsrichanalai C, Tangkeo P, Nitichai Y, Rienprayoon D (1986) "Metabolic effects of depot-medroxyprogesterone acetate in long-term users: a cross-sectional study." Int J Gynaecol Obstet, 24, p. 291-6
  35. Dimitriadis G, Tegos C, Golfinopoulou L, Roboti C, Raptis S (1993) "Furosemide-induced hyperglycaemia - the implication of glycolytic kinases." Horm Metab Res, 25, p. 557-9
  36. Goldman JA, Ovadia JL (1969) "The effect of estrogen on intravenous glucose tolerance in woman." Am J Obstet Gynecol, 103, p. 172-8
  37. Hannaford PC, Kay CR (1989) "Oral contraceptives and diabetes mellitus." BMJ, 299, p. 1315-6
  38. Spellacy WN, Ellingson AB, Tsibris JC (1989) "The effects of two triphasic oral contraceptives on carbohydrate metabolism in women during 1 year of use." Fertil Steril, 51, p. 71-4
  39. 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
  40. Domenet JG (1968) "Diabetogenic effect of oral diuretics." Br Med J, 3, p. 188
  41. Coni NK, Gordon PW, Mukherjee AP, Read PR (1974) "The effect of frusemide and ethacrynic acid on carbohydrate metabolism." Age Ageing, 3, p. 85-90
  42. Schmitz O, Hermansen K, Nielsen OH, Christensen CK, Arnfred J, Hansen HE, Mogensen CE, Orskov H, Beck-Nielsen H (1986) "Insulin action in insulin-dependent diabetics after short-term thiazide therapy." Diabetes Care, 9, p. 631-6
  43. Blayac JP, Ribes G, Buys D, Puech R, Loubatieres-Mariani MM (1981) "Effects of a new benzothiadiazine derivative, LN 5330, on insulin secretion." Arch Int Pharmacodyn Ther, 253, p. 154-63
  44. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L (1983) "Incidence and importance of metabolic side-effects during antihypertensive therapy." Acta Med Scand Suppl, 672, p. 79-83
  45. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC (1980) "Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations." Clin Pharmacol Ther, 28, p. 611-8
  46. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H (1986) "The metabolic effects of thiazide therapy in the elderly: a population study." Age Ageing, 15, p. 151-5
  47. (2001) "Product Information. Glucophage (metformin)." Bristol-Myers Squibb
  48. Harper R, Ennis CN, Heaney AP, Sheridan B, Gormley M, Atkinson AB, Johnston GD, Bell PM (1995) "A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM." Diabetologia, 38, p. 853-9
  49. (2001) "Product Information. Precose (acarbose)." Bayer
  50. (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical
  51. (2001) "Product Information. Amaryl (glimepiride)." Hoechst Marion Roussel
  52. Charan VD, Desai N, Singh AP, Choudhry VP (1993) "Diabetes mellitus and pancreatitis as a complication of L- asparaginase therapy." Indian Pediatr, 30, p. 809-10
  53. Seifer DB, Freedman LN, Cavender JR, Baker RA (1990) "Insulin-dependent diabetes mellitus associated with danazol." Am J Obstet Gynecol, 162, p. 474-5
  54. (2001) "Product Information. Crixivan (indinavir)." Merck & Co., Inc
  55. Pickkers P, Schachter M, Hughes AD, Feher MD, Sever PS (1996) "Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels?" Diabetologia, 39, p. 861-4
  56. (2001) "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc
  57. Dube MP, Johnson DL, Currier JS, Leedom JM (1997) "Protease inhibitor-associated hyperglycaemia." Lancet, 350, p. 713-4
  58. (2001) "Product Information. Oncaspar (pegaspargase)." Rhone Poulenc Rorer
  59. (2001) "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc
  60. (2001) "Product Information. Elspar (asparaginase)." Merck & Co., Inc
  61. (2022) "Product Information. Hyperstat (diazoxide)." Apothecon Inc
  62. (2001) "Product Information. Megace (megestrol)." Bristol-Myers Squibb
  63. Walli R, Demant T (1998) "Impaired glucose tolerance and protease inhibitors." Ann Intern Med, 129, p. 837-8
  64. (2001) "Product Information. Agenerase (amprenavir)." Glaxo Wellcome
  65. Mauss S, Wolf E, Jaeger H (1999) "Impaired glucose tolerance in HIV-positive patients receiving and those not receiving protease inhibitors." Ann Intern Med, 130, p. 162-3
  66. Kaufman MB, Simionatto C (1999) "A review of protease inhibitor-induced hyperglycemia." Pharmacotherapy, 19, p. 114-7
  67. (2001) "Product Information. Tolinase (tolazamide)." Pharmacia and Upjohn
  68. (2001) "Product Information. Orinase (tolbutamide)." Pharmacia and Upjohn
  69. (2001) "Product Information. Dymelor (acetohexamide)." Lilly, Eli and Company
  70. Wehring H, Alexander B, Perry PJ (2000) "Diabetes mellitus associated with clozapine therapy." Pharmacotherapy, 20, p. 844-7
  71. Tsiodras S, Mantzoros C, Hammer S, Samore M (2000) "Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy - A 5-year cohort study." Arch Intern Med, 160, p. 2050-6
  72. (2001) "Product Information. Fortovase (saquinavir)." Roche Laboratories
  73. (2001) "Product Information. Starlix (nateglinide)." Novartis Pharmaceuticals
  74. Hardy H, Esch LD, Morse GD (2001) "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother, 35, p. 343-51
  75. Leary WP, Reyes AJ (1984) "Drug interactions with diuretics." S Afr Med J, 65, p. 455-61
  76. (2022) "Product Information. NovoLOG Mix 70/30 (insulin aspart-insulin aspart protamine)." Novo Nordisk Pharmaceuticals Inc
  77. (2003) "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb
  78. (2003) "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline
  79. (2004) "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals
  80. (2006) "Product Information. Prezista (darunavir)." Ortho Biotech Inc
  81. (2006) "Product Information. Zolinza (vorinostat)." Merck & Co., Inc
  82. (2007) "Product Information. Torisel (temsirolimus)." Wyeth-Ayerst Laboratories
  83. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
  84. (2019) "Product Information. Elzonris (tagraxofusp)." Stemline Therapeutics
  85. (2019) "Product Information. Piqray (alpelisib)." Novartis Pharmaceuticals
View all 85 references

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Drug and food interactions

Moderate

chlorpheniramine food

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

dextromethorphan food

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

glimepiride food

Applies to: glimepiride

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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Moderate

aspirin food

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

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Moderate

phenylephrine food

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr (1979) "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res, 1, p. 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA (1970) "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther, 11, p. 656
  3. (2001) "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc
  4. (2001) "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals
  5. (2001) "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals
  6. (2001) "Product Information. Focalin (dexmethylphenidate)." Mikart Inc
  7. (2002) "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company
View all 7 references

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Minor

aspirin food

Applies to: aspirin / chlorpheniramine / dextromethorphan / phenylephrine

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6

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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.

See also

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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

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

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