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Drug Interactions between exenatide and octreotide

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

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Interactions between your drugs

Moderate

octreotide exenatide

Applies to: octreotide and exenatide

MONITOR: Somatostatin analogs may alter the therapeutic response to insulin and other antidiabetic agents. Somatostatin analogs can induce hyperglycemia and, less frequently, hypoglycemia, by inhibiting the secretion of various counter-regulatory hormones involved in glucose homeostasis (i.e., glucagon, insulin, growth hormone, incretin hormones). Overt diabetes and dose change requirements in insulin or oral antidiabetic therapy have been reported. One patient with no history of hyperglycemia developed severe hyperglycemia followed by pneumonia and subsequently died after initiation of octreotide therapy. Severe, symptomatic hypoglycemia has also been reported, primarily in patients with type I diabetes mellitus. Octreotide has been associated with 50% reductions in blood glucose levels and/or insulin requirements in some insulin-dependent patients.

MANAGEMENT: Close monitoring of diabetic control is recommended if somatostatin analogs are prescribed to patients with preexisting diabetes. Glycemic status including fasting plasma glucose and/or hemoglobin A1c should be assessed prior to initiation of therapy and periodically during therapy in accordance with manufacturer's product labeling, and the antidiabetic treatment adjusted as necessary.

References (9)
  1. Giustina A, Girelli A, Buffoli MG, et al. (1991) "Low-dose octreotide is able to cause a maximal inhibition of the glycemic responses to a mixed meal in obese type 2 diabetic patients treated with insulin." Diabetes Res Clin Pract, 14, p. 47-54
  2. (2001) "Product Information. Sandostatin (octreotide)." Sandoz Pharmaceuticals Corporation
  3. Di Mauro M, Le Moli R, Nicoletti F, Lunetta F (1993) "Effects of octreotide on the glycemic levels in insulin-dependent diabetic patients. Comparative study between administration through multiple subcutaneous injections and continuous subcutaneous infusion." Diabetologia, 36(Suppl 1), A138
  4. Rios MS, Navascues I, Saban J, Ordonez A, Sevilla F, Del Pozo E (1986) "Somatostatin analog SMS 201-995 and insulin needs in insulin-dependent diabetic patients studied by means of an artificial pancreas." J Clin Endocrinol Metab, 63, p. 1071-4
  5. Hadjidakis DJ, Halvatsiotis PG, Ioannou YJ, Mavrokefalos PJ, Raptis SA (1988) "The effects of the somatostatin analogue SMS 201-995 on carbohydrate homeostasis of insulin-dependent diabetics as assessed by the artificial endocrine pancreas." Diabetes Res Clin Pract, 5, p. 91-8
  6. Davies RR, Miller M, Turner SJ, et al. (1986) "Effects of somatostatin analogue SMS 201-995 in non-insulin-dependent diabetes." Clin Endocrinol (Oxf), 25, p. 739-47
  7. Williams G, Fuessl HS, Burrin JM, Chilvers E, Bloom SR (1988) "Postprandial glycaemic effects of a long-acting somatostatin analogue (octreotide) in non-insulin diabetes mellitus." Horm Metab Res, 20, p. 168-70
  8. (2007) "Product Information. Somatuline Depot (lanreotide)." Ipsen Inc
  9. (2013) "Product Information. Signifor (pasireotide)." Novartis Pharmaceuticals

Drug and food interactions

Moderate

octreotide food

Applies to: octreotide

MONITOR: Due to their gastrointestinal pharmacologic effects, somatostatin analogs (e.g., octreotide, lanreotide) may variously affect the absorption of dietary nutrients and concomitantly administered oral medications. Somatostatin analogs have been shown to prolong gastrointestinal transit time and inhibit intestinal absorption of some nutrients such as fat. Clinical data are limited, however. In case reports, octreotide has been reported to reduce the relative bioavailability of cyclosporine. Transplant rejection and significant reductions in cyclosporine levels, sometimes to undetectable levels, have been reported in association with the interaction. Vitamin K absorption was not affected when concomitantly administered with lanreotide according to the manufacturer.

MANAGEMENT: Clinicians should be aware of the potential for altered absorption of concomitantly administered oral medications during treatment with somatostatin analogs. Blood levels and clinical response should be monitored, particularly for drugs that have a narrow therapeutic index, and the dosages adjusted as necessary.

References (5)
  1. Landgraf R, Landgraf-Leurs MM, Nusser J, et al. (1987) "Effect of somatostatin analogue (SMS201-995) on cyclosporine levels." Transplantation, 44, p. 724-5
  2. Ho PJ, Boyajy LD, Greenstein E, Barkan AL (1993) "Effect of chronic octreotide treatment on intestinal absorption in patients with acromegaly." Dig Dis Sci, 38, p. 309-15
  3. Katz MD, Erstad BL (1989) "Octreotide, a new somatostatin analogue." Clin Pharm, 8, p. 255-73
  4. (2001) "Product Information. Sandostatin (octreotide)." Sandoz Pharmaceuticals Corporation
  5. (2007) "Product Information. Somatuline Depot (lanreotide)." Ipsen Inc
Moderate

exenatide food

Applies to: exenatide

ADJUST DOSING INTERVAL: Exenatide slows gastric emptying and may reduce the extent and rate of absorption of concomitantly administered oral medications. When acetaminophen 1000 mg was administered simultaneously with exenatide 10 mcg and also one hour, 2 hours, and 4 hours after exenatide injection, acetaminophen systemic exposure (AUC) was decreased by 21%, 23%, 24%, and 14%, respectively; peak plasma concentration (Cmax) was decreased by 37%, 56%, 54%, and 41%, respectively; and time to peak plasma concentration (Tmax) was increased from 0.6 hours in the control period to 0.9 hours, 4.2 hours, 3.3 hours, and 1.6 hours, respectively. These values were not significantly changed when acetaminophen was given one hour before exenatide injection.

MANAGEMENT: Concomitantly administered oral medications that are dependent on threshold concentrations for efficacy (e.g., antibiotics, contraceptives) or that require rapid gastrointestinal absorption (e.g., hypnotics, pain medications) should be administered at least 1 hour before exenatide. If such medications are to be administered with food, patients should be advised to take them with a meal or snack when exenatide is not administered.

References (1)
  1. (2005) "Product Information. Byetta (exenatide)." Amylin Pharmaceuticals Inc

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.

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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

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