Drug Interactions between exenatide and ginseng

MONITOR: Coadministration of ginseng with antidiabetic drugs may potentiate the risk of hypoglycemia. Clinical data are conflicting. Some small studies have reported that ginseng reduced the blood levels of glucose and/or glycosylated hemoglobin (HbA1c) in diabetic patients, whereas others have not. Furthermore, the lack of standardized preparations of ginseng may limit the generalization of study results. In a double-blind, randomized cross-over trial, 24 diabetic patients received either 1 g/meal (3 g/day) of American ginseng (AG) extract or placebo for 8 weeks while maintaining their original antidiabetic treatments. Compared to placebo, AG significantly reduced HbA1c by 0.29% and fasting blood glucose by 0.71 mmol/L. In another study, 36 non-insulin dependent diabetic patients received 100 mg or 200 mg ginseng extract containing 4 mg or 8 mg of ginsenoside, respectively or placebo once daily for 8 weeks. Compared to placebo, HbA1c was reduced by 0.5% and fasting blood glucose by 0.9 mmol/L in the 200 mg ginseng extract group. However, in contrast, other randomized, double-blind, placebo controlled studies reported no effect of ginseng on HbA1c.

MANAGEMENT: Until more information is available, blood glucose should be monitored if antidiabetic agents are used concomitantly with ginseng. Patients should be advised on the potential signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia), how to treat it, and to contact their doctor if it occurs. Patients should also be advised to take precautions to avoid hypoglycemia while driving or operating hazardous machinery.