Drug Interactions between insulin inhalation, rapid acting and landiolol

Consumer information for this interaction is not currently available.

MONITOR: Beta-blockers may inhibit some of the normal physiologic response to hypoglycemia. Symptoms of hypoglycemia such as tremor and tachycardia may be absent, making it more difficult for patients to recognize an oncoming episode. In addition, multiple effects on glucose metabolism have been reported, usually with the noncardioselective beta-blockers (e.g., propranolol, pindolol, timolol) but occasionally also with relatively beta-1 selective agents (e.g., atenolol, metoprolol, nebivolol). Specifically, inhibition of catecholamine-mediated glycogenolysis and glucose mobilization in association with beta-blockade can potentiate insulin-induced hypoglycemia in diabetics and delay the recovery of normal blood glucose levels. Prolonged and severe hypoglycemia may occur, although these events have rarely been reported. Significant increases in blood pressure and bradycardia can also occur during hypoglycemia in diabetics treated with insulin and beta-blockers due to antagonism of epinephrine's effect on beta-2 adrenergic receptors, which leads to unopposed alpha-adrenergic effects including vasoconstriction. On the other hand, decreased glucose tolerance and decreased glucose-induced insulin secretion have also been reported with various beta-blockers. For example, cardioselective beta-blockers like atenolol have been noted to increase insulin resistance while others such metoprolol and the noncardioselective propranolol are known to increase hepatic glycogenolysis and gluconeogenesis, which may contribute to hyperglycemia. However, beta-blockers with intrinsic sympathomimetic activity and alpha-adrenergic activity, such as labetalol and pindolol, or those with alpha-blocking effects, such as carvedilol, are reported to have a lesser impact on insulin sensitivity and may even have neutral or mildly positive effects on glycemic control due to vasodilating and insulin-sensitizing effects. The extent to which these opposing effects manifest clinically and whether one effect will predominate are unclear.

MANAGEMENT: In general, cardioselective beta-blockers are considered safer than noncardioselective agents in the treatment of diabetic patients. Nevertheless, caution is advised if they are prescribed to patients treated with insulin or oral antidiabetic agents that can cause hypoglycemia (e.g., insulin secretagogues), as cardioselectivity is not absolute and larger doses of beta-1 selective agents may pose some of the same risks as nonselective agents. Due to the potential for hypoglycemia and/or hyperglycemia, patients should be advised of the need for regular blood glucose monitoring. They should be made aware that certain symptoms of hypoglycemia such as tremor and tachycardia may be masked. However, other symptoms such as headache, dizziness, drowsiness, confusion, nausea, hunger, weakness, and perspiration may be unaffected. The same precautions are applicable in diabetic patients treated with ophthalmic beta-blockers.