Drug Interactions between exenatide and pasireotide

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.