Interactions between HC Pram and Linagliptin
1 drug interaction and 11 additional warnings found for the following 2 drugs:
- HC Pram (hydrocortisone/pramoxine topical)
- linagliptin
Drug interactions
Moderate drug interactions
Moderate:
hydrocortisone topical linagliptin
Applies to: HC Pram (hydrocortisone / pramoxine topical) and linagliptin
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.
References (12)
- Seale JP, Compton MR (1986) "Side-effects of corticosteroid agents." Med J Aust, 144, p. 139-42
- Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R (1993) "Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans." Diabetologia, 36, p. 84-7
- Carruthers JA, Staughton RC, August PJ (1977) "Penetration of topical steroid preparations." Arch Dermatol, 113, p. 522
- Pace WE (1973) "Topical corticosteroids." Can Med Assoc J, 108, 11 passim
- (2022) "Product Information. Ultravate (halobetasol topical)." Apothecon Inc
- (2001) "Product Information. Diprolene (betamethasone topical)." Schering Corporation
- "Product Information. Temovate (clobetasol topical)." Glaxo Wellcome
- (2001) "Product Information. Psorcon (diflorasone topical)." Rhone Poulenc Rorer
- Sue LY, milanesi a (2023) Acute hyperglycemia due to topical corticosteroid administration. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334317/
- (2022) "Product Information. Dermovate (clobetasol topical)." GlaxoSmithKline UK Ltd
- James R, Dhatariya K (2018) "Management of hyperglycaemia and steroid (glucocorticoid) therapy: a guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care group" Diabetic Medicine Journal, 35, p. 1011-1017
- (2026) "Product Information. Awiqli FlexTouch (insulin icodec)." Novo Nordisk Pharmaceuticals Inc
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
linagliptin Food/Lifestyle
Applies to: linagliptin
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 (11)
- Jerntorp P, Almer LO (1981) "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand, 656, p. 33-6
- Jerntorp P, Almer LO, Holin H, et al. (1983) "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol, 24, p. 237-42
- Barnett AH, Spiliopoulos AJ, Pyke DA, et al. (1983) "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia, 24, p. 213-5
- Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A (1987) "Interaction of ethanol and glipizide in humans." Diabetes Care, 10, p. 683-6
- (2002) "Product Information. Diabinese (chlorpropamide)." Pfizer U.S. Pharmaceuticals
- (2002) "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals
- "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
- Skillman TG, Feldman JM (1981) "The pharmacology of sulfonylureas." Am J Med, 70, p. 361-72
- (2002) "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), S50-S60
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2026) "Product Information. Awiqli FlexTouch (insulin icodec)." Novo Nordisk Pharmaceuticals Inc
Disease interactions
10 potential interactions Applies to: 10 conditions, including Diabetes Mellitus, Cataract, Liver Disease, Pancreatitis, and Infection.
Abnormal Glucose Tolerance
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Abnormal Glucose Tolerance.
Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Systemic absorption of topical corticosteroids may occur depending on the vehicle and concentration of the preparation, the size of the application area, the integrity of the skin, and the duration of administration. Use of occlusive dressings over the applied areas may also increase percutaneous absorption. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults.
Cataract
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Cataract.
Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with a history of cataracts, glaucoma, or increased intraocular pressure, especially when potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) are used in the periorbital area. Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios.
Diabetes Mellitus
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Diabetes Mellitus.
Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Systemic absorption of topical corticosteroids may occur depending on the vehicle and concentration of the preparation, the size of the application area, the integrity of the skin, and the duration of administration. Use of occlusive dressings over the applied areas may also increase percutaneous absorption. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults.
Diaper Rash
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Diaper Rash.
Topical corticosteroids, especially the potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol), are generally not recommended for use in the treatment of diaper rash. Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are usually at the greatest risk for systemic toxicity such as adrenal suppression, Cushing's syndrome and intracranial hypertension because of their larger skin surface to body mass ratios. If topical corticosteroids are necessary to treat diaper rash, medium- to low-potency agents should preferably be used, and parents should be advised not to put tight-fitting diapers or plastic pants over the rash, since occlusion of treated area may increase percutaneous drug absorption.
Glaucoma/Intraocular Hypertension
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Glaucoma/Intraocular Hypertension.
Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with a history of cataracts, glaucoma, or increased intraocular pressure, especially when potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) are used in the periorbital area. Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios.
Hyperadrenocorticism
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Hyperadrenocorticism.
The use of topical corticosteroids may precipitate or aggravate conditions of hyperadrenocorticism. Systemic absorption of these agents can produce reversible hypothalamic-pituitary-adrenal axis suppression. Systemic absorption, depends on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Patients with an altered skin barrier or liver failure are also at increased risk. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. The development of symptoms such as menstrual irregularities, acneiform lesions, cataracts and cushingoid features during topical corticosteroid therapy may indicate excessive use.
Infection
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Infection.
Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Clinically significant local as well as systemic immunosuppressant and anti-inflammatory effects may occur, which can cause or exacerbate an infection. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Therapy with topical corticosteroids should be administered cautiously in patients with latent or active infections, particularly if a potent agent is used on a large area for prolonged periods or if occlusive dressings are used. Effective antimicrobial therapy or other appropriate treatment should be instituted to treat the infection. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. Occlusive dressings should not be used in patients with skin infection.
Liver Disease
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Liver Disease.
The use of topical corticosteroids may precipitate or aggravate conditions of hyperadrenocorticism. Systemic absorption of these agents can produce reversible hypothalamic-pituitary-adrenal axis suppression. Systemic absorption, depends on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Patients with an altered skin barrier or liver failure are also at increased risk. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. The development of symptoms such as menstrual irregularities, acneiform lesions, cataracts and cushingoid features during topical corticosteroid therapy may indicate excessive use.
Pancreatitis
Moderate:
linagliptin
Linagliptin has a moderate potential interaction with Pancreatitis.
There have been postmarketing reports of acute pancreatitis in patients taking DPP-4 inhibitors. These drugs should be used with caution in patients with a history of pancreatitis or pancreatic disease, although it is unknown if they are at increased risk. Patients should be observed for signs and symptoms of pancreatitis during treatment. If pancreatitis is suspected, treatment should be discontinued immediately and appropriate management should be initiated.
Tuberculosis, Latent
Moderate:
HC Pram
The hydrocortisone topical in HC Pram has a moderate potential interaction with Tuberculosis, Latent.
Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Clinically significant local as well as systemic immunosuppressant and anti-inflammatory effects may occur, which can cause or exacerbate an infection. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Therapy with topical corticosteroids should be administered cautiously in patients with latent or active infections, particularly if a potent agent is used on a large area for prolonged periods or if occlusive dressings are used. Effective antimicrobial therapy or other appropriate treatment should be instituted to treat the infection. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. Occlusive dressings should not be used in patients with skin infection.
More resources
HC Pram
A total of 56 drugs are known to interact with HC Pram.
- Hc pram is in the drug class anorectal preparations.
- Hc pram is used to treat the following conditions:
linagliptin
A total of 399 drugs are known to interact with linagliptin.
- Linagliptin is in the drug class dipeptidyl peptidase 4 inhibitors.
- Linagliptin is used to treat Type 2 Diabetes.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
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