Drug Interaction Report

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.

ADJUST DOSING INTERVAL: Exenatide slows gastric emptying and may reduce the extent and rate of absorption of concomitantly administered oral medications. When acetaminophen 1000 mg was administered simultaneously with exenatide 10 mcg and also one hour, 2 hours, and 4 hours after exenatide injection, acetaminophen systemic exposure (AUC) was decreased by 21%, 23%, 24%, and 14%, respectively; peak plasma concentration (Cmax) was decreased by 37%, 56%, 54%, and 41%, respectively; and time to peak plasma concentration (Tmax) was increased from 0.6 hours in the control period to 0.9 hours, 4.2 hours, 3.3 hours, and 1.6 hours, respectively. These values were not significantly changed when acetaminophen was given one hour before exenatide injection.

MANAGEMENT: Concomitantly administered oral medications that are dependent on threshold concentrations for efficacy (e.g., antibiotics, contraceptives) or that require rapid gastrointestinal absorption (e.g., hypnotics, pain medications) should be administered at least 1 hour before exenatide. If such medications are to be administered with food, patients should be advised to take them with a meal or snack when exenatide is not administered.