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Drug Interactions between Humalog Mix 50/50 KwikPen and Pentacarinat

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

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Interactions between your drugs

Moderate

pentamidine insulin lispro

Applies to: Pentacarinat (pentamidine) and Humalog Mix 50/50 KwikPen (insulin lispro/insulin lispro protamine)

MONITOR: Pentamidine may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of pentamidine has been associated with disturbances in blood glucose homeostasis due to direct toxic effects on beta cells of the pancreas. Hypoglycemia, which may be severe and/or prolonged, as well as hyperglycemia and insulin-dependent diabetes mellitus, the latter of which may be irreversible, have been reported. The onset of pentamidine-induced hypoglycemia generally varied from 5 to 7 days after start of therapy to several days after therapy stops. In some cases, hyperglycemia and progression to diabetes followed, although these effects have occurred independently also. Pancreatic toxicity has been reported with both parenteral use and, less frequently, oral inhalation of pentamidine. The risk appears to be related to total cumulative dosage and prior therapy with the drug, particularly within the last 3 months. Renal impairment also appears to be a risk factor.

MANAGEMENT: Blood glucose should be monitored closely during and after pentamidine therapy in patients receiving insulin or other antidiabetic agents, especially if they are elderly or have renal impairment. Patients should learn to recognize the symptoms of hypoglycemia such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypo- or hyperglycemia occur during pentamidine therapy, patients should initiate appropriate remedial therapy immediately and contact their physician. Dosage adjustments may be required if an interaction is suspected.

References

  1. Bouchard PH, Sai P, Reach G, et al. "Diabetes mellitus following pentamidine-induced hypoglycemia in humans." Diabetes 31 (1982): 40-5
  2. Stahl-Bayliss CM, Kalman CM, Laskin OL "Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome." Clin Pharmacol Ther 39 (1986): 271-5
  3. Shen M, Orwoll ES, Conte JE, Prince MJ "Pentamidine-induced pancreatic beta-cell dysfunction." Am J Med 86 (1989): 726-8
  4. Millard PS, van der Horst C "Reversible diabetes mellitus after intravenous pentamidine." Am J Med 91 (1991): 442
  5. Wood G, Wetzig N, Hogan P, Whitby M "Survival from pentamidine induced pancreatitis and diabetes mellitus." Aust N Z J Med 21 (1991): 341-2
  6. "Product Information. Nebupent (pentamidine)." Fujisawa PROD
  7. "Product Information. Pentam 300 (pentamidine)." Fujisawa PROD (2001):
  8. Kallas EG, Galvao LL, Roland RK, Medeiros EA, Levi GC, Mendonca JS "Pentamidine induced ketoacidosis in acquired immunodeficiency syndrome patients." Int Conf AIDS 9 (1993): 474
  9. Ostrowski M, Walmsley S, Pluemecke G, Salit I, Rachlis A, Krajden S "Pentamidine-induced diabetes mellitus (PIDM)." Int Conf AIDS 9 (1993): 465
  10. Liegl U, Bogner JR, Goebel FD "Insulin-dependent diabetes mellitus following pentamidine therapy in a patient with AIDS." Clin Investig 72 (1994): 1027-9
  11. Assan R, Mayaud C, Perronne C, Matheron S, Assan D, Zucman D, Chotard L "Pentamidine-induced derangements of glucose homeostasis: determinant roles of renal failure and drug accumulation - a study of 128 patients." Diabetes Care 18 (1995): 47-55
  12. Coyle P, Carr AD, Depczynski BB, Chisholm DJ "Diabetes mellitus associated with pentamidine use in HIV-infected patients." Med J Aust 165 (1996): 587-8
  13. Chan JC, Cockram CS, Critchley JA "Drug-induced disorders of glucose metabolism. Mechanisms and management." Drug Saf 15 (1996): 135-57
  14. "Product Information. Lantus (insulin glargine)." Aventis Pharmaceuticals PROD (2001):
  15. "Product Information. NovoLOG (insulin aspart)." Novo Nordisk Pharmaceuticals Inc (2022):
  16. Hardy H, Esch LD, Morse GD "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother 35 (2001): 343-51
View all 16 references

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Moderate

pentamidine insulin lispro protamine

Applies to: Pentacarinat (pentamidine) and Humalog Mix 50/50 KwikPen (insulin lispro/insulin lispro protamine)

MONITOR: Pentamidine may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of pentamidine has been associated with disturbances in blood glucose homeostasis due to direct toxic effects on beta cells of the pancreas. Hypoglycemia, which may be severe and/or prolonged, as well as hyperglycemia and insulin-dependent diabetes mellitus, the latter of which may be irreversible, have been reported. The onset of pentamidine-induced hypoglycemia generally varied from 5 to 7 days after start of therapy to several days after therapy stops. In some cases, hyperglycemia and progression to diabetes followed, although these effects have occurred independently also. Pancreatic toxicity has been reported with both parenteral use and, less frequently, oral inhalation of pentamidine. The risk appears to be related to total cumulative dosage and prior therapy with the drug, particularly within the last 3 months. Renal impairment also appears to be a risk factor.

MANAGEMENT: Blood glucose should be monitored closely during and after pentamidine therapy in patients receiving insulin or other antidiabetic agents, especially if they are elderly or have renal impairment. Patients should learn to recognize the symptoms of hypoglycemia such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypo- or hyperglycemia occur during pentamidine therapy, patients should initiate appropriate remedial therapy immediately and contact their physician. Dosage adjustments may be required if an interaction is suspected.

References

  1. Bouchard PH, Sai P, Reach G, et al. "Diabetes mellitus following pentamidine-induced hypoglycemia in humans." Diabetes 31 (1982): 40-5
  2. Stahl-Bayliss CM, Kalman CM, Laskin OL "Pentamidine-induced hypoglycemia in patients with the acquired immune deficiency syndrome." Clin Pharmacol Ther 39 (1986): 271-5
  3. Shen M, Orwoll ES, Conte JE, Prince MJ "Pentamidine-induced pancreatic beta-cell dysfunction." Am J Med 86 (1989): 726-8
  4. Millard PS, van der Horst C "Reversible diabetes mellitus after intravenous pentamidine." Am J Med 91 (1991): 442
  5. Wood G, Wetzig N, Hogan P, Whitby M "Survival from pentamidine induced pancreatitis and diabetes mellitus." Aust N Z J Med 21 (1991): 341-2
  6. "Product Information. Nebupent (pentamidine)." Fujisawa PROD
  7. "Product Information. Pentam 300 (pentamidine)." Fujisawa PROD (2001):
  8. Kallas EG, Galvao LL, Roland RK, Medeiros EA, Levi GC, Mendonca JS "Pentamidine induced ketoacidosis in acquired immunodeficiency syndrome patients." Int Conf AIDS 9 (1993): 474
  9. Ostrowski M, Walmsley S, Pluemecke G, Salit I, Rachlis A, Krajden S "Pentamidine-induced diabetes mellitus (PIDM)." Int Conf AIDS 9 (1993): 465
  10. Liegl U, Bogner JR, Goebel FD "Insulin-dependent diabetes mellitus following pentamidine therapy in a patient with AIDS." Clin Investig 72 (1994): 1027-9
  11. Assan R, Mayaud C, Perronne C, Matheron S, Assan D, Zucman D, Chotard L "Pentamidine-induced derangements of glucose homeostasis: determinant roles of renal failure and drug accumulation - a study of 128 patients." Diabetes Care 18 (1995): 47-55
  12. Coyle P, Carr AD, Depczynski BB, Chisholm DJ "Diabetes mellitus associated with pentamidine use in HIV-infected patients." Med J Aust 165 (1996): 587-8
  13. Chan JC, Cockram CS, Critchley JA "Drug-induced disorders of glucose metabolism. Mechanisms and management." Drug Saf 15 (1996): 135-57
  14. "Product Information. Lantus (insulin glargine)." Aventis Pharmaceuticals PROD (2001):
  15. "Product Information. NovoLOG (insulin aspart)." Novo Nordisk Pharmaceuticals Inc (2022):
  16. Hardy H, Esch LD, Morse GD "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother 35 (2001): 343-51
View all 16 references

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Drug and food interactions

Moderate

insulin lispro food

Applies to: Humalog Mix 50/50 KwikPen (insulin lispro/insulin lispro protamine)

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
View all 10 references

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Moderate

insulin lispro protamine food

Applies to: Humalog Mix 50/50 KwikPen (insulin lispro/insulin lispro protamine)

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
View all 10 references

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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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