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Drug Interactions between MTE-5 and Novolin 70/30 PenFill

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

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Interactions between your drugs

Moderate

chromic chloride hexahydrate insulin regular

Applies to: MTE-5 (chromic chloride hexahydrate / copper sulfate / manganese sulfate / selenium / zinc sulfate) and Novolin 70 / 30 PenFill (insulin isophane / insulin regular)

MONITOR: Pharmacologic dosages of chromium (200 mcg/day or more for adults) may help improve diabetic control and reduce the requirements for insulin and other antidiabetic agents. Chromium appears to play a role in normal insulin function and glucose utilization, and some investigators have suggested that it increases insulin sensitivity and glucose tolerance and decreases blood glucose levels in certain diabetics, possibly those with low chromium levels. However, others have not corroborated these findings, and a few have even reported a negative effect on glucose tolerance and blood levels.

MANAGEMENT: Until further data are available, therapy with pharmacologic dosages of chromium should be administered cautiously in patients receiving insulin or other antidiabetic agents. Patients should be monitored for changes in diabetic medication requirements.

References

  1. Bratman S, Kroll D. "The Natural Health Bible: From the Most Trusted Alternative Health Site in the World--Your A-Z Guide to over 300 Conditions, Herbs, Vitamins, and Supplements." Roseville, CA: Prima Health (2000):
  2. Mertz W "Interaction of chromium with insulin: a progress report." Nutr Rev 56 (1998): 174-7
  3. Fox GN, Sabovic Z "Chromium picolinate supplementation for diabetes mellitus." J Fam Pract 46 (1998): 83-6
  4. Anderson RA "Chromium, glucose intolerance and diabetes." J Am Coll Nutr 17 (1998): 548-55
  5. Anderson RA, cheng N, Bryden NA, et al. "Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes." Diabetes 46 (1997): 1786-91
  6. Abraham AS, Brooks BA, Eylath U "The effects of chromiium supplementation on serum glucose and lipids in patients with and without non-insulin-dependent diabetes." Metabolism 41 (1992): 768-71
  7. Althuis MD, Jordan NE, Ludington EA, Wittes JT "Glucose and insulin responses to dietary chromium supplements: a meta-analysis." Am J Clin Nutr 76 (2002): 148-55
  8. Gunton JE, Cheung NW, Hitchman R, et al. "Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: a randomized, placebo-controlled, double-blind trial of supplementation in subjects with impaired glucose tolerance." Diabetes Care 28 (2005): 712-3
  9. Martin J, Wang ZQ, Zhang XH, et al. "Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes." Diabetes Care 29 (2006): 1826-32
View all 9 references

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Moderate

chromic chloride hexahydrate insulin isophane (NPH)

Applies to: MTE-5 (chromic chloride hexahydrate / copper sulfate / manganese sulfate / selenium / zinc sulfate) and Novolin 70 / 30 PenFill (insulin isophane / insulin regular)

MONITOR: Pharmacologic dosages of chromium (200 mcg/day or more for adults) may help improve diabetic control and reduce the requirements for insulin and other antidiabetic agents. Chromium appears to play a role in normal insulin function and glucose utilization, and some investigators have suggested that it increases insulin sensitivity and glucose tolerance and decreases blood glucose levels in certain diabetics, possibly those with low chromium levels. However, others have not corroborated these findings, and a few have even reported a negative effect on glucose tolerance and blood levels.

MANAGEMENT: Until further data are available, therapy with pharmacologic dosages of chromium should be administered cautiously in patients receiving insulin or other antidiabetic agents. Patients should be monitored for changes in diabetic medication requirements.

References

  1. Bratman S, Kroll D. "The Natural Health Bible: From the Most Trusted Alternative Health Site in the World--Your A-Z Guide to over 300 Conditions, Herbs, Vitamins, and Supplements." Roseville, CA: Prima Health (2000):
  2. Mertz W "Interaction of chromium with insulin: a progress report." Nutr Rev 56 (1998): 174-7
  3. Fox GN, Sabovic Z "Chromium picolinate supplementation for diabetes mellitus." J Fam Pract 46 (1998): 83-6
  4. Anderson RA "Chromium, glucose intolerance and diabetes." J Am Coll Nutr 17 (1998): 548-55
  5. Anderson RA, cheng N, Bryden NA, et al. "Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes." Diabetes 46 (1997): 1786-91
  6. Abraham AS, Brooks BA, Eylath U "The effects of chromiium supplementation on serum glucose and lipids in patients with and without non-insulin-dependent diabetes." Metabolism 41 (1992): 768-71
  7. Althuis MD, Jordan NE, Ludington EA, Wittes JT "Glucose and insulin responses to dietary chromium supplements: a meta-analysis." Am J Clin Nutr 76 (2002): 148-55
  8. Gunton JE, Cheung NW, Hitchman R, et al. "Chromium supplementation does not improve glucose tolerance, insulin sensitivity, or lipid profile: a randomized, placebo-controlled, double-blind trial of supplementation in subjects with impaired glucose tolerance." Diabetes Care 28 (2005): 712-3
  9. Martin J, Wang ZQ, Zhang XH, et al. "Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes." Diabetes Care 29 (2006): 1826-32
View all 9 references

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Drug and food interactions

Moderate

insulin regular food

Applies to: Novolin 70 / 30 PenFill (insulin isophane / insulin regular)

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 isophane (NPH) food

Applies to: Novolin 70 / 30 PenFill (insulin isophane / insulin regular)

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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