Skip to main content

Drug Interactions between dulaglutide and pentamidine

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

pentamidine dulaglutide

Applies to: pentamidine and dulaglutide

MONITOR: Pentamidine may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of pentamidine has been associated with disturbances in blood glucose homeostasis due to direct toxic effects on beta cells of the pancreas. Hypoglycemia, which may be severe and/or prolonged, as well as hyperglycemia and insulin-dependent diabetes mellitus, the latter of which may be irreversible, have been reported. The onset of pentamidine-induced hypoglycemia generally varied from 5 to 7 days after start of therapy to several days after therapy stops. In some cases, hyperglycemia and progression to diabetes followed, although these effects have occurred independently also. Pancreatic toxicity has been reported with both parenteral use and, less frequently, oral inhalation of pentamidine. The risk appears to be related to total cumulative dosage and prior therapy with the drug, particularly within the last 3 months. Renal impairment also appears to be a risk factor.

MANAGEMENT: Blood glucose should be monitored closely during and after pentamidine therapy in patients receiving insulin or other antidiabetic agents, especially if they are elderly or have renal impairment. Patients should learn to recognize the symptoms of hypoglycemia such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypo- or hyperglycemia occur during pentamidine therapy, patients should initiate appropriate remedial therapy immediately and contact their physician. Dosage adjustments may be required if an interaction is suspected.

References

  1. Bouchard PH, Sai P, Reach G, et al. (1982) "Diabetes mellitus following pentamidine-induced hypoglycemia in humans." Diabetes, 31, p. 40-5
  2. Stahl-Bayliss CM, Kalman CM, Laskin OL (1986) "Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome." Clin Pharmacol Ther, 39, p. 271-5
  3. Shen M, Orwoll ES, Conte JE, Prince MJ (1989) "Pentamidine-induced pancreatic beta-cell dysfunction." Am J Med, 86, p. 726-8
  4. Millard PS, van der Horst C (1991) "Reversible diabetes mellitus after intravenous pentamidine." Am J Med, 91, p. 442
  5. Wood G, Wetzig N, Hogan P, Whitby M (1991) "Survival from pentamidine induced pancreatitis and diabetes mellitus." Aust N Z J Med, 21, p. 341-2
  6. "Product Information. Nebupent (pentamidine)." Fujisawa
  7. (2001) "Product Information. Pentam 300 (pentamidine)." Fujisawa
  8. Kallas EG, Galvao LL, Roland RK, Medeiros EA, Levi GC, Mendonca JS (1993) "Pentamidine induced ketoacidosis in acquired immunodeficiency syndrome patients." Int Conf AIDS, 9, p. 474
  9. Ostrowski M, Walmsley S, Pluemecke G, Salit I, Rachlis A, Krajden S (1993) "Pentamidine-induced diabetes mellitus (PIDM)." Int Conf AIDS, 9, p. 465
  10. Liegl U, Bogner JR, Goebel FD (1994) "Insulin-dependent diabetes mellitus following pentamidine therapy in a patient with AIDS." Clin Investig, 72, p. 1027-9
  11. Assan R, Mayaud C, Perronne C, Matheron S, Assan D, Zucman D, Chotard L (1995) "Pentamidine-induced derangements of glucose homeostasis: determinant roles of renal failure and drug accumulation - a study of 128 patients." Diabetes Care, 18, p. 47-55
  12. Coyle P, Carr AD, Depczynski BB, Chisholm DJ (1996) "Diabetes mellitus associated with pentamidine use in HIV-infected patients." Med J Aust, 165, p. 587-8
  13. Chan JC, Cockram CS, Critchley JA (1996) "Drug-induced disorders of glucose metabolism. Mechanisms and management." Drug Saf, 15, p. 135-57
  14. (2001) "Product Information. Lantus (insulin glargine)." Aventis Pharmaceuticals
  15. (2022) "Product Information. NovoLOG (insulin aspart)." Novo Nordisk Pharmaceuticals Inc
  16. Hardy H, Esch LD, Morse GD (2001) "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother, 35, p. 343-51
View all 16 references

Switch to consumer interaction data

Drug and food interactions

Moderate

dulaglutide food

Applies to: dulaglutide

MONITOR: Glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists can delay gastric emptying, which may impact the absorption of concomitantly administered oral medications. Mild to moderate decreases in plasma concentrations of coadministered drugs have been demonstrated in pharmacokinetic studies for some GLP-1 receptor agonists (e.g., exenatide, lixisenatide), but not others. According to the prescribing information, liraglutide did not affect the absorption of several orally administered drugs to any clinically significant extent, including acetaminophen, atorvastatin, digoxin, griseofulvin, lisinopril, and an oral contraceptive containing ethinyl estradiol-levonorgestrel. Likewise, no clinically relevant effect on absorption was observed for concomitantly administered oral drugs studied with albiglutide (digoxin, ethinyl estradiol-norethindrone, simvastatin, warfarin), dulaglutide (acetaminophen, atorvastatin, digoxin, ethinyl estradiol-norelgestromin, lisinopril, metformin, metoprolol, sitagliptin, warfarin), or semaglutide (atorvastatin, digoxin, ethinyl estradiol-levonorgestrel, metformin, warfarin). The impact of dual GLP-1 and GIP receptor agonist tirzepatide on gastric emptying was reported to be dose- and time-dependent, with the greatest effect observed after a single 5 mg dose but diminished after subsequent doses. When acetaminophen was administered following a single 5 mg dose of tirzepatide, acetaminophen peak plasma concentration (Cmax) was decreased by 50% and its median time to peak plasma concentration (Tmax) delayed by 1 hour. However, no significant impact on acetaminophen Cmax and Tmax was observed after 4 consecutive weekly doses of tirzepatide (5 mg/5 mg/8 mg/10 mg), and the overall exposure (AUC) of acetaminophen was unaffected. Tirzepatide at lower doses of 0.5 mg and 1.5 mg also had minimal effects on acetaminophen exposure.

MANAGEMENT: Although no specific dosage adjustment of concomitant medications is generally recommended based on available data, potential clinical impact on some oral medications cannot be ruled out, particularly those with a narrow therapeutic index or low bioavailability, those that depend on threshold concentrations for efficacy (e.g., antibiotics), and those that require rapid gastrointestinal absorption (e.g., hypnotics, analgesics). Pharmacologic response to concomitantly administered oral medications should be monitored more closely following initiation, dose adjustment, or discontinuation of a GLP-1 receptor agonist or a dual GLP-1 and GIP receptor agonist.

References

  1. (2005) "Product Information. Byetta (exenatide)." Amylin Pharmaceuticals Inc
  2. (2010) "Product Information. Victoza (liraglutide)." Novo Nordisk Pharmaceuticals Inc
  3. (2014) "Product Information. Tanzeum (albiglutide)." GlaxoSmithKline
  4. (2014) "Product Information. Trulicity (dulaglutide)." Eli Lilly and Company
  5. (2016) "Product Information. Adlyxin (lixisenatide)." sanofi-aventis
  6. (2022) "Product Information. Ozempic (1 mg dose) (semaglutide)." Novo Nordisk Pharmaceuticals Inc
  7. (2023) "Product Information. Mounjaro (tirzepatide)." Eli Lilly and Company Ltd
  8. (2023) "Product Information. Mounjaro (tirzepatide)." Lilly, Eli and Company
  9. Eli Lilly Canada Inc. (2023) Product monograph including patient medication information MOUNJARO tirzepatide injection. https://pdf.hres.ca/dpd_pm/00068421.PDF
View all 9 references

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer