Drug Interactions between Embeline and Iletin NPH

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

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

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