Drug Interaction Report

MONITOR: Treatment with pegvisomant may increase glucose tolerance in some diabetic patients, potentially reducing their requirements for insulin and other antidiabetic agents. The mechanism is pegvisomant antagonism of endogenous growth hormone, the latter of which normally decreases insulin sensitivity and opposes the effects of insulin on carbohydrate metabolism. However, clinically relevant hypoglycemia was not observed in diabetic patients who were treated with pegvisomant in premarketing trials.

MANAGEMENT: Close clinical monitoring of glycemic control is recommended when pegvisomant is used in patients receiving insulin or other antidiabetic agents, and the dosages of these agents adjusted as necessary. Likewise, patients may be at risk for hyperglycemia when pegvisomant is withdrawn from their therapeutic regimen.

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.