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Drug Interactions between glyburide / metformin and Trycet

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

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Moderate

glyBURIDE propoxyphene

Applies to: glyburide / metformin and Trycet (acetaminophen / propoxyphene)

MONITOR: The hypoglycemic effect of insulin secretagogues (e.g., sulfonylureas, meglitinides) may be potentiated by certain drugs, including ACE inhibitors, 4-aminoquinolines, amylin analogs, anabolic steroids, fibrates, monoamine oxidase inhibitors (MAOIs, including linezolid), nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, selective serotonin reuptake inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinine, quinidine, and ginseng. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, fibrates, ginseng); stimulating insulin secretion (salicylates, NSAIDs, disopyramide, quinine, quinidine, MAOIs, ginseng); decreasing insulin clearance and resistance (4-aminoquinolines); increasing peripheral glucose utilization (SSRIs, insulin-like growth factor); inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor); slowing the rate of gastric emptying (amylin analogs); and/or suppressing postprandial glucagon secretion (amylin analogs). Or, they may increase plasma concentration of insulin secretagogues by displacing them from plasma protein binding sites and/or inhibiting their metabolism (fibrates, NSAIDs, salicylates, sulfonamides). Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or sulfonylureas. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases.

MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin secretagogues, particularly in patients with advanced age and/or renal impairment. The oral antidiabetic dosage(s) may require adjustment if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their doctor if it occurs. Patients should be observed for loss of glycemic control when these drugs are withdrawn.

References

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  8. Johnson J, Dobmeier M "Symptomatic hypoglycemia secondary to a glipizide-trimethoprim/sulfamethoxazole drug interaction." DICP 24 (1990): 250-1
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  34. Wing LM, Miners JO "Cotrimoxazole as an inhibitor of oxidative drug metabolism: effects of trimethoprim and sulphamethoxazole separately and combined on tolbutamide disposition." Br J Clin Pharmacol 20 (1985): 482-5
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  37. Sjoberg S, Wiholm BE, Gunnarsson R, Emilsson H, Thunberg E, Christenson I, Ostman J "Lack of pharmacokinetic interaction between glibenclamide and trimethoprim-sulphamethoxazole." Diabet Med 4 (1987): 245-7
  38. Diwan PV, Sastry MS, Satyanarayana NV "Potentiation of hypoglycemic response of glibenclamide by piroxicam in rats and humans." Indian J Exp Biol 30 (1992): 317-9
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  40. Slade IH, and Iosefa RN "Fatal hypoglycemic coma from the use of tolbutamide in elderly patients: report of two cases." J Am Geriatr Soc 15 (1967): 948-50
  41. David DS, Steere AC Jr, Pi-Sunyer XF, Sakai S, Clark SB "Aspirin-induced hypoglycaemia in a patient on haemodialysis." Lancet 2 (1971): 1092-3
  42. Cattaneo AG, Caviezel F, Pozza G "Pharmacological interaction between tolbutamide and acetylsalicylic acid: study on insulin secretion in man." Int J Clin Pharmacol Ther Toxicol 28 (1990): 229-34
  43. Pond SM, Birkett DJ, Wade DN "Mechanisms of inhibition of tolbutamide metabolism: phenylbutazone, oxyphenbutazone, sulfaphenazole." Clin Pharmacol Ther 22 (1977): 573-9
  44. Christensen LK, Hansen JM, Kristensen M "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics." Lancet 2 (1963): 1298-301
  45. Harris EL "Adverse reactions to oral antidiabetic agents." Br Med J 3 (1971): 29-30
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  47. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  48. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  49. "Product Information. Micronase (glyburide)." Pharmacia and Upjohn PROD (2002):
  50. Turtle JR, Burgess JA "Hypoglycemic action of fenfluramine in diabetes mellitus." Diabetes 22 (1973): 858-67
  51. Ferriere M, Lachkar H, Richard JL, Bringer J, Orsetti A, Mirouze J "Captopril and insulin sensitivity." Ann Intern Med 102 (1985): 134-5
  52. Johnson JA, Kappel JE, Sharif MN "Hypoglycemia secondary to trimethoprim/sulfamethoxazole administration in a renal transplant patient." Ann Pharmacother 27 (1993): 304-6
  53. Almirall J, Montoliu J, Torras A, Revert L "Propoxyphene-induced hypoglycemia in a patient with chronic renal failure." Nephron 53 (1989): 273-5
  54. Hayashi S, Horie M, Tsuura Y, Ishida H, Okada Y, Seino Y, Sasayama S "Disopyramide blocks pancreatic ATP-sensitive K+ channels and enhances insulin release." Am J Physiol 265 (1993): c337-42
  55. Phillips AF, Matty PJ, Porte PJ, Raye JR "Inhibition of glucose-induced insulin secretion by indomethacin and sodium salicylate in the fetal lamb." Am J Obstet Gynecol 148 (1984): 481-7
  56. Baron SH "Salicylates as hypoglycemic agents." Diabetes Care 5 (1982): 64-71
  57. Prince RL, Larkins RG, Alford FP "The effect of acetylsalicylic acid on plasma glucose and the response of glucose regulatory hormones to intravenous glucose and arginine in insulin treated diabetics and normal subjects." Metabolism 30 (1981): 293-8
  58. Ferrari C, Fressati S, Romussi M, et al. "Effects of short-term clofibrate administration on glucose tolerance and insulin secretion in patients with chemical diabetes or hypertriglyceridemia." Metabolism 26 (1977): 129-39
  59. Storlien LH, Thorburn AW, Smythe GA, Jenkins AB, Chisholm DJ, Kraegen EW "Effect of d-fenfluramine on basal glucose turnover and fat-feeding-induced insulin resistance in rats." Diabetes 38 (1989): 499-503
  60. Pestell RG, Crock PA, Ward GM, Alford FP, Best JD "Fenfluramine increases insulin action in patients with NIDDM." Diabetes Care 12 (1989): 252-8
  61. Harrison LC, King-Roach A, Martin FI, Melick RA "The effect of fenfluramine on insulin binding and on basal and insulin-stimulated oxidation of 1-C-glucose by human adipose tissue." Postgrad Med J 51 Suppl 1 (1975): 110-4
  62. Feldman JM, Chapman B "Monoamine oxidase inhibitors: nature of their interaction with rabbit pancreatic islets to alter insulin secretion." Diabetologia 11 (1975): 487-94
  63. Aleyassine H, Gardiner RJ "Dual action of antidepressant drugs (MAO inhibitors) on insulin release." Endocrinology 96 (1975): 702-10
  64. Aleyassine H, Lee SH "Inhibition of insulin release by substrates and inhibitors of monoamine oxidase." Am J Physiol 222 (1972): 565-9
  65. Cooper AJ, Ashcroft G "Potentiation of insulin hypoglycaemia by M.A.O.I. antidepressant drugs." Lancet 1 (1966): 407-9
  66. Lozada A, Dujovne CA "Drug interactions with fibric acids." Pharmacol Ther 63 (1994): 163-76
  67. Kradjan WA, Witt DM, Opheim KE, Wood FC "Lack of interaction between glipizide and co-trimoxazole." J Clin Pharmacol 34 (1994): 997-1002
  68. Herings RMC, Deboer A, Stricker BHC, Leufkens HGM, Porsius A "Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme." Lancet 345 (1995): 1195-8
  69. Ahmad S "Drug interaction induces hypoglycemia." J Fam Pract 40 (1995): 540-1
  70. Feher MD, Amiel S "ACE inhibitors and hypoglycaemia." Lancet 346 (1995): 125-6
  71. Paolisso G, Balbi V, Gambardella A, Varricchio G, Tortoriello R, Saccomanno F, Amato L, Varricchio M "Lisinopril administration improves insulin action in aged patients with hypertension." J Hum Hypertens 9 (1995): 541-6
  72. Darcy PF, Griffin JP "Interactions with drugs used in the treatment of depressive illness." Adverse Drug React Toxicol Rev 14 (1995): 211-31
  73. Kubacka RT, Antla EJ, Juhl RP, Welshman IR "Effects of aspirin and ibuprofen on the pharmacokinetics and pharmacodynamics of glyburide in healthy subjects." Ann Pharmacother 30 (1996): 20-6
  74. "Product Information. Amaryl (glimepiride)." Hoechst Marion Roussel PROD (2001):
  75. Deeg MA, Lipkin EW "Hypoglycemia associated with the use of fluoxetine." West J Med 164 (1996): 262-3
  76. Hartmann D, Korn A, Komjati M, Heinz G, Haefelfinger P, Defoin R, Waldhausl WK "Lack of effect of tenoxicam on dynamic responses to concurrent oral doses of glucose and glibenclamide." Br J Clin Pharmacol 30 (1990): 245-52
  77. Hellman B "Potentiating effects of drugs on the binding of glibenclamide to pancreatic beta cells." Metabolism 23 (1974): 839-46
  78. Morrison PJ, Rogers HJ, Spector RG, Bradbrook ID, John VA "Effect of pirprofen on glibenclamide kinetics and response." Br J Clin Pharmacol 14 (1982): 123-6
  79. Hekimsoy Z, Biberoglu S, Comlekci A, Tarhan O, Mermut C, Biberoglu K "Trimethoprim/sulfamethoxazole-induced hypoglycemia in a malnourished patient with severe infection." Eur J Endocrinol 136 (1997): 3046
  80. "Product Information. Prandin (repaglinide)." Novo Nordisk Pharmaceuticals Inc PROD (2001):
  81. Iida H, Morita T, Suzuki E, Iwasawa K, Toyooka T, Nakajima T "Hypoglycemia induced by interaction between clarithromycin and disopyramide." Jpn Heart J 40 (1999): 91-6
  82. Morris AD, Newton RW, Boyle DI, et al. "ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes." Diabetes Care 20 (1997): 1363-7
  83. "Product Information. Tolinase (tolazamide)." Pharmacia and Upjohn PROD (2001):
  84. "Product Information. Orinase (tolbutamide)." Pharmacia and Upjohn PROD (2001):
  85. "Product Information. Dymelor (acetohexamide)." Lilly, Eli and Company PROD (2001):
  86. "Product Information. Starlix (nateglinide)." Novartis Pharmaceuticals PROD (2001):
  87. Niemi M, Backman JT, Neuvonen M, Laitila J, Neuvonen PJ, Kivisto KT "Effects of fluconazole and fluvoxamine on the pharmacokinetics and pharmacodynamics of glimepiride." Clin Pharmacol Ther 69 (2001): 194-200
  88. Abad S, Moachon L, Blanche P, Bavoux F, Sicard D, Salmon-Ceron D "Possible interaction between glicazide, fluconazole and sulfamethoxazole resulting in severe hypoglycaemia." Br J Clin Pharmacol 52 (2001): 456-7
  89. Pollak PT, Mukherjee SD, Fraser AD "Sertraline-induced hypoglycemia." Ann Pharmacother 35 (2001): 1371-4
  90. Tran PO, Gleason CE, Robertson RP "Inhibition of interleukin-1beta-induced COX-2 and EP3 gene expression by sodium salicylate enhances pancreatic islet beta-cell function." Diabetes 51 (2002): 1772-8
  91. Hundal RS, Petersen KF, Mayerson AB, et al. "Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes." J Clin Invest 109 (2002): 1321-6
  92. Tremaine LM, Wilner KD, Preskorn SH "A study of the potential effect of sertraline on the pharmacokinetics and protein binding of tolbutamide." Clin Pharmacokinet 32(Suppl 1) (1997): 31-36
  93. "Product Information. Apidra (insulin glulisine)." Aventis Pharmaceuticals (2004):
  94. Fogari R, Zoppi A, Corradi L, Pierangelo L, Mugellini A, Lusardi P "Comparative effects of lisinopril and losartan on insulin sensitivity in the treatment of non diabetic hypertension." Br J Clin Pharmacol 46 (1998): 467-71
  95. Sone H, Takahashi A, Yamada N "Ibuprofen-related hypoglycemia in a patient receiving sulfonylurea." Ann Intern Med 134 (2001): 344
  96. Sawka AM, Burgart V, Zimmerman D "Loss of awareness of hypoglycemia temporally associated with selective serotonin reuptake inhibitors." Diabetes Care 24 (2001): 1845-6
  97. "Product Information. Increlex (mecasermin)." Tercica Inc (2005):
  98. Vuksan V, Sievenpiper JL, Koo VY, et al. "American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus." Arch Intern Med 160 (2000): 1009-13
  99. Vuksan V, Stavro MP, Sievenpiper JL, et al. "Similar postprandial glycemic reductions with escalation of dose and administration time of American ginseng in type 2 diabetes." Diabetes Care 23 (2000): 1221-6
  100. Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L.) with a depressed ginsenoside profile does not affect postprandial glycemia." Eur J Clin Nutr 57 (2003): 243-8
  101. World Health Organization "WHO Public Assessment Reports (WHOPARs) https://extranet.who.int/pqweb/medicines/prequalification-reports/whopars" (2020):
View all 101 references

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Moderate

glyBURIDE metFORMIN

Applies to: glyburide / metformin and glyburide / metformin

MONITOR: Coadministration of metformin with an insulin secretagogue (e.g., sulfonylurea, meglitinide) or insulin may potentiate the risk of hypoglycemia. Although metformin alone generally does not cause hypoglycemia under normal circumstances of use, the added therapeutic effect when combined with other antidiabetic agents may result in hypoglycemia. The risk is further increased when caloric intake is deficient or when strenuous exercise is not compensated by caloric supplementation.

MANAGEMENT: A lower dosage of the insulin secretagogue or insulin may be required when used with metformin. Blood glucose should be closely monitored, and patients should be educated on the potential signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, tachycardia) and appropriate remedial actions to take if it occurs. Patients should also be advised to take precautions to avoid hypoglycemia while driving or operating hazardous machinery.

References

  1. Wiernsperger N, Rapin JR "Metformin-insulin interactions: from organ to cell." Diabetes Metab Rev 11 Suppl (1995): s3-12
  2. Okada S, Ishii K, Hamada H, Tanokuchi S, Ichiki K, Ota Z "Can alpha-glucosidase inhibitors reduce the insulin dosage administered to patients with non-insulin-dependent diabetes mellitus?" J Int Med Res 23 (1995): 487-91

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Drug and food interactions

Major

propoxyphene food

Applies to: Trycet (acetaminophen / propoxyphene)

GENERALLY AVOID: Alcohol may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.

MANAGEMENT: The use of alcohol during propoxyphene therapy should be avoided. Patients should be warned not to exceed the recommended dosage of propoxyphene and to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company PROD (2001):

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Major

metFORMIN food

Applies to: glyburide / metformin

GENERALLY AVOID: Alcohol can potentiate the effect of metformin on lactate metabolism and increase the risk of lactic acidosis. In addition, alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Although hypoglycemia rarely occurs during treatment with metformin alone, the risk may increase with acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes.

Food may have varying effects on the absorption of metformin from immediate-release versus extended-release formulations. When a single 850 mg dose of immediate-release metformin was administered with food, mean peak plasma concentration (Cmax) and systemic exposure (AUC) decreased by 40% and 25%, respectively, and time to peak plasma concentration (Tmax) increased by 35 minutes compared to administration under fasting conditions. By contrast, administration of extended-release metformin with food increased AUC by 50% without affecting Cmax or Tmax, and both high- and low-fat meals had the same effect. These data may not be applicable to formulations that contain metformin with other oral antidiabetic agents.

MANAGEMENT: Metformin should be taken with meals, and excessive alcohol intake should be avoided during treatment. Diabetes patients in general should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Alcohol should not be consumed on an empty stomach or following exercise, as it may increase the risk of hypoglycemia. Patients should contact their physician immediately if they experience potential signs and symptoms of lactic acidosis such as malaise, myalgia, respiratory distress, increasing somnolence, and nonspecific abdominal distress (especially after stabilization of metformin therapy, when gastrointestinal symptoms are uncommon). With more marked acidosis, there may also be associated hypothermia, hypotension, and resistant bradyarrhythmias. Metformin should be withdrawn promptly if lactic acidosis is suspected. Serum electrolytes, ketones, blood glucose, blood pH, lactate levels, and blood metformin levels may be useful in establishing a diagnosis. Lactic acidosis should be suspected in any diabetic patient with metabolic acidosis lacking evidence of ketoacidosis (ketonuria and ketonemia).

References

  1. "Product Information. Glucophage (metformin)." Bristol-Myers Squibb PROD (2001):
  2. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60

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Major

acetaminophen food

Applies to: Trycet (acetaminophen / propoxyphene)

GENERALLY AVOID: Chronic, excessive consumption of alcohol may increase the risk of acetaminophen-induced hepatotoxicity, which has included rare cases of fatal hepatitis and frank hepatic failure requiring liver transplantation. The proposed mechanism is induction of hepatic microsomal enzymes during chronic alcohol use, which may result in accelerated metabolism of acetaminophen and increased production of potentially hepatotoxic metabolites.

MANAGEMENT: In general, chronic alcoholics should avoid regular or excessive use of acetaminophen. Alternative analgesic/antipyretic therapy may be appropriate in patients who consume three or more alcoholic drinks per day. However, if acetaminophen is used, these patients should be cautioned not to exceed the recommended dosage (maximum 4 g/day in adults and children 12 years of age or older).

References

  1. Kaysen GA, Pond SM, Roper MH, Menke DJ, Marrama MA "Combined hepatic and renal injury in alcoholics during therapeutic use of acetaminophen." Arch Intern Med 145 (1985): 2019-23
  2. O'Dell JR, Zetterman RK, Burnett DA "Centrilobular hepatic fibrosis following acetaminophen-induced hepatic necrosis in an alcoholic." JAMA 255 (1986): 2636-7
  3. Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB "Acetaminophen hepatotoxicity in alcoholics." Ann Intern Med 104 (1986): 399-404
  4. Thummel KE, Slattery JT, Nelson SD "Mechanism by which ethanol diminishes the hepatotoxicity of acetaminophen." J Pharmacol Exp Ther 245 (1988): 129-36
  5. McClain CJ, Kromhout JP, Peterson FJ, Holtzman JL "Potentiation of acetaminophen hepatotoxicity by alcohol." JAMA 244 (1980): 251-3
  6. Kartsonis A, Reddy KR, Schiff ER "Alcohol, acetaminophen, and hepatic necrosis." Ann Intern Med 105 (1986): 138-9
  7. Prescott LF, Critchley JA "Drug interactions affecting analgesic toxicity." Am J Med 75 (1983): 113-6
  8. "Product Information. Tylenol (acetaminophen)." McNeil Pharmaceutical PROD (2002):
  9. Whitcomb DC, Block GD "Association of acetaminopphen hepatotoxicity with fasting and ethanol use." JAMA 272 (1994): 1845-50
  10. Bonkovsky HL "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  11. Nelson EB, Temple AR "Acetaminophen hepatotoxicity, fasting, and ethanol." JAMA 274 (1995): 301
  12. Zimmerman HJ, Maddrey WC "Acetaminophen (paracetamol) hepatotoxicity with regular intake of alcohol: analysis of instances of therapeutic misadventure." Hepatology 22 (1995): 767-73
View all 12 references

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Moderate

glyBURIDE food

Applies to: glyburide / metformin

GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

References

  1. Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6
  2. Jerntorp P, Almer LO, Holin H, et al. "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6
  5. "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  6. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72
  9. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60
  10. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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