Drug Interaction Report

The alclometasone topical in Aclovate has a moderate potential interaction with Abnormal Glucose Tolerance.

Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Systemic absorption of topical corticosteroids may occur depending on the vehicle and concentration of the preparation, the size of the application area, the integrity of the skin, and the duration of administration. Use of occlusive dressings over the applied areas may also increase percutaneous absorption. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults.

TOLBUTamide has a major potential interaction with Adrenal Insufficiency.

The use of insulin is contraindicated during episodes of hypoglycemia. Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including but not limited to those who are debilitated or malnourished, those with renal or hepatic impairment, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those with reduced awareness of hypoglycemia. Symptomatic awareness of hypoglycemia may be reduced in patients with longstanding diabetes, diabetic nerve disease, recurrent hypoglycemia, or concomitant medications that block the sympathetic nervous system (e.g., beta-blockers). Changes to any glucose-lowering medications, meal pattern, or physical activity may also increase risk of hypoglycemia. Increased frequency of glucose monitoring is recommended in patients at higher risk for hypoglycemia.

TOLBUTamide has a major potential interaction with Anorexia/Feeding Problems.

The use of insulin is contraindicated during episodes of hypoglycemia. Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including but not limited to those who are debilitated or malnourished, those with renal or hepatic impairment, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those with reduced awareness of hypoglycemia. Symptomatic awareness of hypoglycemia may be reduced in patients with longstanding diabetes, diabetic nerve disease, recurrent hypoglycemia, or concomitant medications that block the sympathetic nervous system (e.g., beta-blockers). Changes to any glucose-lowering medications, meal pattern, or physical activity may also increase risk of hypoglycemia. Increased frequency of glucose monitoring is recommended in patients at higher risk for hypoglycemia.

TOLBUTamide has a major potential interaction with Autonomic Neuropathy.

The use of insulin is contraindicated during episodes of hypoglycemia. Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including but not limited to those who are debilitated or malnourished, those with renal or hepatic impairment, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those with reduced awareness of hypoglycemia. Symptomatic awareness of hypoglycemia may be reduced in patients with longstanding diabetes, diabetic nerve disease, recurrent hypoglycemia, or concomitant medications that block the sympathetic nervous system (e.g., beta-blockers). Changes to any glucose-lowering medications, meal pattern, or physical activity may also increase risk of hypoglycemia. Increased frequency of glucose monitoring is recommended in patients at higher risk for hypoglycemia.

TOLBUTamide has a major potential interaction with Cardiovascular Conditions and Disorders.

The use of oral hypoglycemic agents may be associated with an increased risk of cardiovascular mortality compared to treatment with diet alone or diet with insulin. This warning is based on the University Group Diabetes Program (UGDP) study, a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. Patients treated with diet plus a fixed dosage of either tolbutamide (a sulfonylurea) or phenformin (a biguanide) for 5 to 8 years had a cardiovascular mortality rate approximately 2.5 times that of patients treated with diet alone, resulting in discontinuation of both these treatments in the study. Despite controversy regarding interpretation of these results, clinicians and patients should be aware of the potential risk when making treatment decisions for diabetes, particularly in the presence of underlying cardiovascular disease. Data are not available for other sulfonylureas or biguanides, nor for hypoglycemic agents belonging to other classes. However, given the similarities in chemical structure and/or mode of action, the same caution should be applied.

The alclometasone topical in Aclovate has a moderate potential interaction with Cataract.

Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with a history of cataracts, glaucoma, or increased intraocular pressure, especially when potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) are used in the periorbital area. Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios.

TOLBUTamide has a moderate potential interaction with Dehydration.

Treatment with sulfonylureas may cause hyponatremia, in patients who are on other medications or have medical conditions known to cause hyponatremia or increase release of antidiuretic hormone. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported with certain sulfonylureas and these drugs may augment the peripheral (antidiuretic) action of ADH and/or increase release of ADH. Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

TOLBUTamide has a major potential interaction with Diabetes, Type 1.

The use of some sulfonylurea agents is contraindicated for the treatment of patients with diabetic ketoacidosis, with or without coma. In addition, these agents should not be used as sole therapy in patients with type I diabetes mellitus.

The alclometasone topical in Aclovate has a moderate potential interaction with Diabetes Mellitus.

Corticosteroids can raise blood glucose level by antagonizing the action and suppressing the secretion of insulin, which results in inhibition of peripheral glucose uptake and increased gluconeogenesis. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with diabetes mellitus, glucose intolerance, or a predisposition to hyperglycemia. Systemic absorption of topical corticosteroids may occur depending on the vehicle and concentration of the preparation, the size of the application area, the integrity of the skin, and the duration of administration. Use of occlusive dressings over the applied areas may also increase percutaneous absorption. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults.

TOLBUTamide has a major potential interaction with Diabetic Ketoacidosis.

The use of some sulfonylurea agents is contraindicated for the treatment of patients with diabetic ketoacidosis, with or without coma. In addition, these agents should not be used as sole therapy in patients with type I diabetes mellitus.

The alclometasone topical in Aclovate has a moderate potential interaction with Diaper Rash.

Topical corticosteroids, especially the potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol), are generally not recommended for use in the treatment of diaper rash. Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are usually at the greatest risk for systemic toxicity such as adrenal suppression, Cushing's syndrome and intracranial hypertension because of their larger skin surface to body mass ratios. If topical corticosteroids are necessary to treat diaper rash, medium- to low-potency agents should preferably be used, and parents should be advised not to put tight-fitting diapers or plastic pants over the rash, since occlusion of treated area may increase percutaneous drug absorption.

TOLBUTamide has a moderate potential interaction with G-6-PD Deficiency.

Sulfonylureas can cause hemolytic anemia in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency. Therapy with these agents should be used with caution in patients with G6PD deficiency and consider the use of a non-sulfonylurea alternative. There have been postmarketing reports of hemolytic anemia in patients receiving these drugs who did not have known G6PD deficiency.

The alclometasone topical in Aclovate has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Prolonged use of corticosteroids may cause posterior subcapsular cataracts and elevated intraocular pressure, the latter of which may lead to glaucoma and/or damage to the optic nerves. Therapy with topical corticosteroids rarely produces these effects but should be administered cautiously nonetheless in patients with a history of cataracts, glaucoma, or increased intraocular pressure, especially when potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) are used in the periorbital area. Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios.

The alclometasone topical in Aclovate has a moderate potential interaction with Hyperadrenocorticism.

The use of topical corticosteroids may precipitate or aggravate conditions of hyperadrenocorticism. Systemic absorption of these agents can produce reversible hypothalamic-pituitary-adrenal axis suppression. Systemic absorption, depends on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Patients with an altered skin barrier or liver failure are also at increased risk. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. The development of symptoms such as menstrual irregularities, acneiform lesions, cataracts and cushingoid features during topical corticosteroid therapy may indicate excessive use.

TOLBUTamide has a major potential interaction with Hypoglycemia.

The use of insulin is contraindicated during episodes of hypoglycemia. Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including but not limited to those who are debilitated or malnourished, those with renal or hepatic impairment, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those with reduced awareness of hypoglycemia. Symptomatic awareness of hypoglycemia may be reduced in patients with longstanding diabetes, diabetic nerve disease, recurrent hypoglycemia, or concomitant medications that block the sympathetic nervous system (e.g., beta-blockers). Changes to any glucose-lowering medications, meal pattern, or physical activity may also increase risk of hypoglycemia. Increased frequency of glucose monitoring is recommended in patients at higher risk for hypoglycemia.

TOLBUTamide has a moderate potential interaction with Hyponatremia.

Treatment with sulfonylureas may cause hyponatremia, in patients who are on other medications or have medical conditions known to cause hyponatremia or increase release of antidiuretic hormone. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported with certain sulfonylureas and these drugs may augment the peripheral (antidiuretic) action of ADH and/or increase release of ADH. Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

The alclometasone topical in Aclovate has a moderate potential interaction with Infection.

Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Clinically significant local as well as systemic immunosuppressant and anti-inflammatory effects may occur, which can cause or exacerbate an infection. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Therapy with topical corticosteroids should be administered cautiously in patients with latent or active infections, particularly if a potent agent is used on a large area for prolonged periods or if occlusive dressings are used. Effective antimicrobial therapy or other appropriate treatment should be instituted to treat the infection. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. Occlusive dressings should not be used in patients with skin infection.

TOLBUTamide has a major potential interaction with Liver Disease.

Serious and prolonged hypoglycemia has been reported in patients with severe renal or liver disease following oral administration of tolbutamide. Diagnostic testing with tolbutamide should be administered cautiously, if necessary, in such patients. If severe hypoglycemic symptoms are observed, the test should be terminated immediately by intravenously injecting 12.5 to 25 g of glucose in a 25% to 50% solution. The patient should be monitored for some time afterwards, since reaction may be prolonged.

The alclometasone topical in Aclovate has a moderate potential interaction with Liver Disease.

The use of topical corticosteroids may precipitate or aggravate conditions of hyperadrenocorticism. Systemic absorption of these agents can produce reversible hypothalamic-pituitary-adrenal axis suppression. Systemic absorption, depends on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Patients with an altered skin barrier or liver failure are also at increased risk. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. The development of symptoms such as menstrual irregularities, acneiform lesions, cataracts and cushingoid features during topical corticosteroid therapy may indicate excessive use.

TOLBUTamide has a major potential interaction with Malnourishment.

The use of insulin is contraindicated during episodes of hypoglycemia. Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including but not limited to those who are debilitated or malnourished, those with renal or hepatic impairment, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those with reduced awareness of hypoglycemia. Symptomatic awareness of hypoglycemia may be reduced in patients with longstanding diabetes, diabetic nerve disease, recurrent hypoglycemia, or concomitant medications that block the sympathetic nervous system (e.g., beta-blockers). Changes to any glucose-lowering medications, meal pattern, or physical activity may also increase risk of hypoglycemia. Increased frequency of glucose monitoring is recommended in patients at higher risk for hypoglycemia.

TOLBUTamide has a major potential interaction with Panhypopituitarism.

The use of insulin is contraindicated during episodes of hypoglycemia. Hypoglycemia may commonly occur during treatment with insulin and/or oral hypoglycemic agents. Care should be taken in patients who may be particularly susceptible to the development of hypoglycemic episodes during the use of these drugs, including but not limited to those who are debilitated or malnourished, those with renal or hepatic impairment, those with defective counterregulatory mechanisms (e.g., autonomic neuropathy and adrenal or pituitary insufficiency), and those with reduced awareness of hypoglycemia. Symptomatic awareness of hypoglycemia may be reduced in patients with longstanding diabetes, diabetic nerve disease, recurrent hypoglycemia, or concomitant medications that block the sympathetic nervous system (e.g., beta-blockers). Changes to any glucose-lowering medications, meal pattern, or physical activity may also increase risk of hypoglycemia. Increased frequency of glucose monitoring is recommended in patients at higher risk for hypoglycemia.

TOLBUTamide has a major potential interaction with Renal Dysfunction.

Serious and prolonged hypoglycemia has been reported in patients with severe renal or liver disease following oral administration of tolbutamide. Diagnostic testing with tolbutamide should be administered cautiously, if necessary, in such patients. If severe hypoglycemic symptoms are observed, the test should be terminated immediately by intravenously injecting 12.5 to 25 g of glucose in a 25% to 50% solution. The patient should be monitored for some time afterwards, since reaction may be prolonged.

TOLBUTamide has a moderate potential interaction with SIADH.

Treatment with sulfonylureas may cause hyponatremia, in patients who are on other medications or have medical conditions known to cause hyponatremia or increase release of antidiuretic hormone. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported with certain sulfonylureas and these drugs may augment the peripheral (antidiuretic) action of ADH and/or increase release of ADH. Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.

The alclometasone topical in Aclovate has a moderate potential interaction with Tuberculosis, Latent.

Topical corticosteroids may be systemically absorbed, depending on the vehicle and concentration of the preparation, the size of the application area, the duration of administration, and whether or not occlusive dressings are used. Clinically significant local as well as systemic immunosuppressant and anti-inflammatory effects may occur, which can cause or exacerbate an infection. Given equivalent doses, small children are generally at the greatest risk because of their larger skin surface to body mass ratios. Therapy with topical corticosteroids should be administered cautiously in patients with latent or active infections, particularly if a potent agent is used on a large area for prolonged periods or if occlusive dressings are used. Effective antimicrobial therapy or other appropriate treatment should be instituted to treat the infection. If possible, the use of highly potent agents (e.g., augmented betamethasone, clobetasol, diflorasone, and halobetasol) should be avoided in children and limited to small areas for 2 weeks in adults. Occlusive dressings should not be used in patients with skin infection.