Drug Interaction Report

MONITOR: Coadministration of ashwagandha with antidiabetic drugs may potentiate the risk of hypoglycemia. Clinical data are conflicting. Some studies have reported that ashwagandha reduced the blood levels of glucose and/or glycosylated hemoglobin (HbA1c) in diabetic patients, whereas others have not. In vitro studies suggest that the antidiabetic actions of ashwagandha are mediated through an increase in cellular glucose uptake in both skeletal and fat cells, and an increase in insulin secretion.

MANAGEMENT: Until more information is available, blood glucose should be monitored if antidiabetic agents are used concomitantly with ashwagandha. Patients should be advised on the potential signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia), how to treat it, and to contact their doctor if it occurs. Patients should also be advised to take precautions to avoid hypoglycemia while driving or operating hazardous machinery.

ADJUST DOSING INTERVAL: Pramlintide slows gastric emptying and may delay the absorption of concomitantly administered oral medications. In a pharmacokinetic study of 24 patients with type 2 diabetes, coadministration with pramlintide (120 mcg) decreased the peak plasma concentration (Cmax) of acetaminophen (1000 mg) by 29% and increased its time to peak plasma concentration (Tmax) based on the time of acetaminophen administration relative to pramlintide injection. Pramlintide significantly increased acetaminophen Tmax (range 48 to 72 minutes) when acetaminophen was administered simultaneously with or up to 2 hours following pramlintide injection, but it had negligible effect when acetaminophen was administered 1 to 2 hours before pramlintide injection.

MANAGEMENT: When rapid onset of a concomitantly administered oral medication is critical to its effectiveness, the medication should be administered at least 1 hour before or 2 hours after pramlintide injection.