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Drug Interactions between Tol-Tab and Zegerid OTC

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

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Interactions between your drugs

Moderate

TOLBUTamide sodium bicarbonate

Applies to: Tol-Tab (tolbutamide) and Zegerid OTC (omeprazole / sodium bicarbonate)

ADJUST DOSING INTERVAL: Some antacids have been reported to increase the rate of absorption and, rarely, the extent of absorption of oral sulfonylureas. The hypoglycemic effects of these agents may be altered.

MANAGEMENT: Sulfonylureas should be administered at least two hours before or after antacids when possible. Regular monitoring of blood sugar is advisable. In addition, 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 physician if it occurs.

References

  1. Kivisto KT, Neuvonen PJ "Effect of magnesium hydroxide on the absorption and efficacy of tolbutamide and chlorpropamide." Eur J Clin Pharmacol 42 (1992): 675-80
  2. Kolterman OG "Glyburide in non-insulin-dependent diabetes: an update." Clin Ther 14 (1992): 196-213
  3. Kivisto KT, Neuvonen PJ "Enhancement of absorption and effect of glipizide by magnesium hydroxide." Clin Pharmacol Ther 49 (1991): 39-43
  4. Prendergast BD "Glyburide and glipizide, second-generation oral sulfonylurea hypoglycemic agents." Clin Pharm 3 (1984): 473-85
  5. "Product Information. Glucotrol (glipizide)." Pfizer U.S. Pharmaceuticals PROD (2002):
  6. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  7. "Product Information. Micronase (glyburide)." Pharmacia and Upjohn PROD (2002):
View all 7 references

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Minor

omeprazole TOLBUTamide

Applies to: Zegerid OTC (omeprazole / sodium bicarbonate) and Tol-Tab (tolbutamide)

Some benzimidazole proton pump inhibitors may increase sulfonylurea concentrations, and hypoglycemic effects may be increased. The mechanism may be inhibition of CYP450 2C19 and/or 3A4 hepatic metabolism. The clinical significance of this interaction is unknown. Patients receiving this combination should be advised to regularly monitor their blood sugar, counseled on how to recognize and treat hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, tremor, hunger, weakness, or palpitations) and to notify their physician if it occurs. The sulfonylurea dosage may require reduction in affected patients.

References

  1. Humphries TJ "Clinical implications of drug interactions with the cytochrome P-450 enzyme system associated with omeprazole." Dig Dis Sci 36 (1991): 1665-9
  2. "Product Information. PriLOSEC (omeprazole)." Merck & Co., Inc (2022):
  3. Toon S, Holt BL, Mullins FGP, Khan A "Effects of cimetidine, ranitidine and omeprazole on tolbutamide pharmacokinetics." J Pharm Pharmacol 47 (1995): 85-8
  4. "Product Information. Nexium (esomeprazole)." Astra-Zeneca Pharmaceuticals PROD (2001):
View all 4 references

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Drug and food interactions

Moderate

TOLBUTamide food

Applies to: Tol-Tab (tolbutamide)

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

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