Drug Interaction Report

MONITOR: Concomitant use of oral products containing aloe vera gel may potentiate the hypoglycemic effect of insulin and other antidiabetic agents. Aloe vera has demonstrated hypoglycemic effects in streptozotocin-induced diabetes in rats, and limited data in diabetic patients have indicated efficacy in reducing blood glucose when used alone or in combination with oral hypoglycemic agents.

MANAGEMENT: Until more data are available, caution is advised when aloe vera is administered orally to patients receiving insulin or other antidiabetic agents due to the potential for increased risk of hypoglycemia. Patients should be monitored for changes in diabetic medication requirements.

ADJUST DOSING INTERVAL: Taking oral semaglutide with food, beverage, or other oral medications may alter semaglutide absorption and exposure. In a controlled study with healthy volunteers, limited or no measurable semaglutide exposure was observed in subjects that were fed 30 minutes prior to taking oral semaglutide, while all subjects that fasted overnight and 30 minutes after the oral semaglutide dose had measurable semaglutide exposure. Area under the curve (AUC) and semaglutide peak plasma concentration (Cmax) were approximately 40% greater in subjects that fasted compared to those who did not. AUC and Cmax were also increased with a post-dose fasting period greater than 30 minutes.

MANAGEMENT: It is recommended that oral semaglutide be taken 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water to ensure its efficacy. Fasting longer than 30 minutes after the oral semaglutide dose may lead to increased gastrointestinal side effects including nausea, vomiting, or diarrhea.