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Drug Interaction Report

4 potential interactions and/or warnings found for the following 2 drugs:

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Moderate

pseudoephedrine empagliflozin

Applies to: Maxifed-G CDX (codeine / guaifenesin / pseudoephedrine), empagliflozin

MONITOR: The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs, including atypical antipsychotics, corticosteroids, diuretics, estrogens, gonadotropin-releasing hormone agonists, human growth hormone, phenothiazines, progestins, protease inhibitors, sympathomimetic amines, thyroid hormones, L-asparaginase, alpelisib, copanlisib, danazol, diazoxide, isoniazid, megestrol, omacetaxine, phenytoin, sirolimus, tagraxofusp, temsirolimus, as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. These drugs may interfere with blood glucose control because they can cause hyperglycemia, glucose intolerance, new-onset diabetes mellitus, and/or exacerbation of preexisting diabetes.

MANAGEMENT: Caution is advised when drugs that can interfere with glucose metabolism are prescribed to patients with diabetes. Close clinical monitoring of glycemic control is recommended following initiation or discontinuation of these drugs, and the dosages of concomitant antidiabetic agents adjusted as necessary. Patients should be advised to notify their physician if their blood glucose is consistently high or if they experience symptoms of severe hyperglycemia such as excessive thirst and increases in the volume or frequency of urination. Likewise, patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen.

References

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  2. Pollare T, Lithell H, Berne C. A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med. 1989;321:868-73.
  3. Carter BL, Small RE, Mandel MD, Starkman MT. Phenytoin-induced hyperglycemia. Am J Hosp Pharm. 1981;38:1508-12.
  4. Al-Rubeaan K, Ryan EA. Phenytoin-induced insulin insensitivity. Diabet Med. 1991;8:968-70.
  5. Chaudhuri ML, Catania J. A comparison of the effects of bumetanide (Burinex) and frusemide on carbohydrate metabolism in the elderly. Br J Clin Pract. 1988;42:427-9.
  6. Goldman JA, Neri A, Ovadia J, Eckerling B, Vries A, de. Effect of chlorothiazide on intravenous glucose tolerance in pregnancy. Am J Obstet Gynecol. 1969;105:556-60.
  7. Miller NR, Moses H. Transient oculomotor nerve palsy. Association with thiazide-induced glucose intolerance. JAMA. 1978;240:1887-8.
  8. Kansal PC, Buse J, Buse MG. Thiazide diuretics and control of diabetes mellitus. South Med J. 1969;62:1372-9.
  9. Andersen OO, Persson I. Carbohydrate metabolism during treatment with chlorthalidone and ethacrynic acid. Br Med J. 1968;2:798-801.
  10. Curtis J, Horrigan F, Ahearn D, Varney R, Sandler SG. Chlorthalidone-induced hyperosmolar hyperglycemic nonketotic coma. JAMA. 1972;220:1592-3.
  11. Chowdhury FR, Bleicher SJ. Chlorthalidone--induced hypokalemia and abnormal carbohydrate metabolism. Horm Metab Res. 1970;2:13-6.
  12. Diamond MT. Hyperglycemic hyperosmolar coma associated with hydrochlorothiazide and pancreatitis. N Y State J Med. 1972;72:1741-2.
  13. Jones IG, Pickens PT. Diabetes mellitus following oral diuretics. Practitioner. 1967;199:209-10.
  14. Black DM, Filak AT. Hyperglycemia with non-insulin-dependent diabetes following intraarticular steroid injection. J Fam Pract. 1989;28:462-3.
  15. Gunnarsson R, Lundgren G, Magnusson G, Ost L, Groth CG. Steroid diabetes--a sign of overtreatment with steroids in the renal graft recipient? Scand J Urol Nephrol Suppl. 1980;54:135-8.
  16. Murphy MB, Kohner E, Lewis PJ, Schumer B, Dollery CT. Glucose intolerance in hypertensive patients treated with diuretics: a fourteen-year follow-up. Lancet. 1982;2:1293-5.
  17. Seltzer HS, Allen EW. Hyperglycemia and inhibition of insulin secretion during administration of diazoxide and trichlormethiazide in man. Diabetes. 1969;18:19-28.
  18. Jori A, Carrara MC. On the mechanism of the hyperglycaemic effect of chlorpromazine. J Pharm Pharmacol. 1966;18:623-4.
  19. Erle G, Basso M, Federspil G, Sicolo N, Scandellari C. Effect of chlorpromazine on blood glucose and plasma insulin in man. Eur J Clin Pharmacol. 1977;11:15-8.
  20. Product Information. Thorazine (chlorpromazine). SmithKline Beecham. 2002;PROD.
  21. Product Information. Diabinese (chlorpropamide). Pfizer U.S. Pharmaceuticals. 2002;PROD.
  22. Product Information. Glucotrol (glipizide). Pfizer U.S. Pharmaceuticals. 2002;PROD.
  23. Product Information. Diabeta (glyburide). Hoechst Marion-Roussel Inc, Kansas City, MO.
  24. Product Information. Synthroid (levothyroxine). Abbott Pharmaceutical. 2002;PROD.
  25. Product Information. Carafate (sucralfate). Hoechst Marion Roussel. 2001;PROD.
  26. Stambaugh JE, Tucker DC. Effect of diphenylhydantoin on glucose tolerance in patients with hypoglycemia. Diabetes. 1974;23:679-83.
  27. Malherbe C, Burrill KC, Levin SR, Karam JH, Forsham PH. Effect of diphenylhydantoin on insulin secretion in man. N Engl J Med. 1972;286:339-42.
  28. Javier Z, Gershberg H, Hulse M. Ovulatory suppressants, estrogens, and carbohydrate metabolism. Metabolism. 1968;17:443-56.
  29. Sotaniemi E, Kontturi M, Larmi T. Effect of diethylstilbestrol on blood glucose of prostatic cancer patients. Invest Urol. 1973;10:438-41.
  30. Bell DS. Insulin resistance. An often unrecognized problem accompanying chronic medical disorders. Postgrad Med. 1993;93:99-103,.
  31. Berlin I. Prazosin, diuretics, and glucose intolerance. Ann Intern Med. 1993;119:860.
  32. Rowe P, Mather H. Hyperosmolar non-ketotic diabetes mellitus associated with metolazone. Br Med J. 1985;291:25-6.
  33. Haiba NA, el-Habashy MA, Said SA, Darwish EA, Abdel-Sayed WS, Nayel SE. Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters. Contraception. 1989;39:619-32.
  34. Virutamasen P, Wongsrichanalai C, Tangkeo P, Nitichai Y, Rienprayoon D. Metabolic effects of depot-medroxyprogesterone acetate in long-term users: a cross-sectional study. Int J Gynaecol Obstet. 1986;24:291-6.
  35. Dimitriadis G, Tegos C, Golfinopoulou L, Roboti C, Raptis S. Furosemide-induced hyperglycaemia - the implication of glycolytic kinases. Horm Metab Res. 1993;25:557-9.
  36. Goldman JA, Ovadia JL. The effect of estrogen on intravenous glucose tolerance in woman. Am J Obstet Gynecol. 1969;103:172-8.
  37. Hannaford PC, Kay CR. Oral contraceptives and diabetes mellitus. BMJ. 1989;299:1315-6.
  38. Spellacy WN, Ellingson AB, Tsibris JC. The effects of two triphasic oral contraceptives on carbohydrate metabolism in women during 1 year of use. Fertil Steril. 1989;51:71-4.
  39. Ludvik B, Clodi M, Kautzky-Willer A, Capek M, Hartter E, Pacini G, Prager R. Effect of dexamethasone on insulin sensitivity, islet amyloid polypeptide and insulin secretion in humans. Diabetologia. 1993;36:84-7.
  40. Domenet JG. Diabetogenic effect of oral diuretics. Br Med J. 1968;3:188.
  41. Coni NK, Gordon PW, Mukherjee AP, Read PR. The effect of frusemide and ethacrynic acid on carbohydrate metabolism. Age Ageing. 1974;3:85-90.
  42. Schmitz O, Hermansen K, Nielsen OH, Christensen CK, Arnfred J, Hansen HE, Mogensen CE, Orskov H, Beck-Nielsen H. Insulin action in insulin-dependent diabetics after short-term thiazide therapy. Diabetes Care. 1986;9:631-6.
  43. Blayac JP, Ribes G, Buys D, Puech R, Loubatieres-Mariani MM. Effects of a new benzothiadiazine derivative, LN 5330, on insulin secretion. Arch Int Pharmacodyn Ther. 1981;253:154-63.
  44. Elmfeldt D, Berglund G, Wedel H, Wilhelmsen L. Incidence and importance of metabolic side-effects during antihypertensive therapy. Acta Med Scand Suppl. 1983;672:79-83.
  45. Winchester JF, Kellett RJ, Boddy K, Boyle P, Dargie HJ, Mahaffey ME, Ward DM, Kennedy AC. Metolazone and bendroflumethiazide in hypertension: physiologic and metabolic observations. Clin Pharmacol Ther. 1980;28:611-8.
  46. Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H. The metabolic effects of thiazide therapy in the elderly: a population study. Age Ageing. 1986;15:151-5.
  47. Product Information. Glucophage (metformin). Bristol-Myers Squibb. 2001;PROD.
  48. Harper R, Ennis CN, Heaney AP, Sheridan B, Gormley M, Atkinson AB, Johnston GD, Bell PM. A comparison of the effects of low- and conventional-dose thiazide diuretic on insulin action in hypertensive patients with NIDDM. Diabetologia. 1995;38:853-9.
  49. Product Information. Precose (acarbose). Bayer. 2001;PROD.
  50. Product Information. Norvir (ritonavir). Abbott Pharmaceutical. 2001;PROD.
  51. Product Information. Amaryl (glimepiride). Hoechst Marion Roussel. 2001;PROD.
  52. Charan VD, Desai N, Singh AP, Choudhry VP. Diabetes mellitus and pancreatitis as a complication of L- asparaginase therapy. Indian Pediatr. 1993;30:809-10.
  53. Seifer DB, Freedman LN, Cavender JR, Baker RA. Insulin-dependent diabetes mellitus associated with danazol. Am J Obstet Gynecol. 1990;162:474-5.
  54. Product Information. Crixivan (indinavir). Merck & Co., Inc. 2001;PROD.
  55. Pickkers P, Schachter M, Hughes AD, Feher MD, Sever PS. Thiazide-induced hyperglycaemia: a role for calcium-activated potassium channels? Diabetologia. 1996;39:861-4.
  56. Product Information. Viracept (nelfinavir). Agouron Pharma Inc. 2001;PROD.
  57. Dube MP, Johnson DL, Currier JS, Leedom JM. Protease inhibitor-associated hyperglycaemia. Lancet. 1997;350:713-4.
  58. Product Information. Oncaspar (pegaspargase). Rhone Poulenc Rorer. 2001;PROD.
  59. Product Information. Prandin (repaglinide). Novo Nordisk Pharmaceuticals Inc. 2001;PROD.
  60. Product Information. Elspar (asparaginase). Merck & Co., Inc. 2001;PROD.
  61. Product Information. Hyperstat (diazoxide). Apothecon Inc. 2022.
  62. Product Information. Megace (megestrol). Bristol-Myers Squibb. 2001;PROD.
  63. Walli R, Demant T. Impaired glucose tolerance and protease inhibitors. Ann Intern Med. 1998;129:837-8.
  64. Product Information. Agenerase (amprenavir). Glaxo Wellcome. 2001;PROD.
  65. Mauss S, Wolf E, Jaeger H. Impaired glucose tolerance in HIV-positive patients receiving and those not receiving protease inhibitors. Ann Intern Med. 1999;130:162-3.
  66. Kaufman MB, Simionatto C. A review of protease inhibitor-induced hyperglycemia. Pharmacotherapy. 1999;19:114-7.
  67. Product Information. Tolinase (tolazamide). Pharmacia and Upjohn. 2001;PROD.
  68. Product Information. Orinase (tolbutamide). Pharmacia and Upjohn. 2001;PROD.
  69. Product Information. Dymelor (acetohexamide). Lilly, Eli and Company. 2001;PROD.
  70. Wehring H, Alexander B, Perry PJ. Diabetes mellitus associated with clozapine therapy. Pharmacotherapy. 2000;20:844-7.
  71. Tsiodras S, Mantzoros C, Hammer S, Samore M. Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy - A 5-year cohort study. Arch Intern Med. 2000;160:2050-6.
  72. Product Information. Fortovase (saquinavir). Roche Laboratories. 2001;PROD.
  73. Product Information. Starlix (nateglinide). Novartis Pharmaceuticals. 2001;PROD.
  74. Hardy H, Esch LD, Morse GD. Glucose disorders associated with HIV and its drug therapy. Ann Pharmacother. 2001;35:343-51.
  75. Leary WP, Reyes AJ. Drug interactions with diuretics. S Afr Med J. 1984;65:455-61.
  76. Product Information. NovoLOG Mix 70/30 (insulin aspart-insulin aspart protamine). Novo Nordisk Pharmaceuticals Inc. 2022.
  77. Product Information. Reyataz (atazanavir). Bristol-Myers Squibb. 2003.
  78. Product Information. Lexiva (fosamprenavir). GlaxoSmithKline. 2003.
  79. Product Information. Apidra (insulin glulisine). Aventis Pharmaceuticals. 2004.
  80. Product Information. Prezista (darunavir). Ortho Biotech Inc. 2006.
  81. Product Information. Zolinza (vorinostat). Merck & Co., Inc. 2006.
  82. Product Information. Torisel (temsirolimus). Wyeth-Ayerst Laboratories. 2007.
  83. Product Information. Rexulti (brexpiprazole). Otsuka American Pharmaceuticals Inc. 2015.
  84. Product Information. Elzonris (tagraxofusp). Stemline Therapeutics. 2019.
  85. Product Information. Piqray (alpelisib). Novartis Pharmaceuticals. 2019.
View all 85 references

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Drug and food interactions

Moderate

empagliflozin food

Applies to: empagliflozin

GENERALLY AVOID: Alcohol may cause hypoglycemia or hyperglycemia in patients with diabetes. Hypoglycemia most frequently occurs during acute consumption of alcohol. Even modest amounts can lower blood sugar significantly, especially when the alcohol is ingested on an empty stomach or following exercise. The mechanism involves inhibition of both gluconeogenesis as well as the counter-regulatory response to hypoglycemia. Episodes of hypoglycemia may last for 8 to 12 hours after ethanol ingestion. By contrast, chronic alcohol abuse can cause impaired glucose tolerance and hyperglycemia. Moderate alcohol consumption generally does not affect blood glucose levels in patients with well controlled diabetes. A disulfiram-like reaction (e.g., flushing, headache, and nausea) to alcohol has been reported frequently with the use of chlorpropamide and very rarely with other sulfonylureas.

MANAGEMENT: Patients with diabetes should avoid consuming alcohol if their blood glucose is not well controlled, or if they have hypertriglyceridemia, neuropathy, or pancreatitis. Patients with well controlled diabetes should limit their alcohol intake to one drink daily for women and two drinks daily for men (1 drink = 5 oz wine, 12 oz beer, or 1.5 oz distilled spirits) in conjunction with their normal meal plan. Alcohol should not be consumed on an empty stomach or following exercise.

References

  1. Jerntorp P, Almer LO. Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes. Acta Med Scand. 1981;656:33-6.
  2. Jerntorp P, Almer LO, Holin H, et al. Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush. Eur J Clin Pharmacol. 1983;24:237-42.
  3. Barnett AH, Spiliopoulos AJ, Pyke DA, et al. Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy. Diabetologia. 1983;24:213-5.
  4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A. Interaction of ethanol and glipizide in humans. Diabetes Care. 1987;10:683-6.
  5. Product Information. Diabinese (chlorpropamide). Pfizer U.S. Pharmaceuticals. 2002;PROD.
  6. Product Information. Glucotrol (glipizide). Pfizer U.S. Pharmaceuticals. 2002;PROD.
  7. Product Information. Diabeta (glyburide). Hoechst Marion-Roussel Inc, Kansas City, MO.
  8. Skillman TG, Feldman JM. The pharmacology of sulfonylureas. Am J Med. 1981;70:361-72.
  9. Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association. Diabetes Care. 2002;25(Suppl 1):S50-S60.
  10. Cerner Multum, Inc. UK Summary of Product Characteristics.
View all 10 references

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Moderate

codeine food

Applies to: Maxifed-G CDX (codeine / guaifenesin / pseudoephedrine)

GENERALLY AVOID: Ethanol may potentiate the central nervous system (CNS) depressant effects of opioid analgesics. Concomitant use may result in additive CNS depression and impairment of judgment, thinking, and psychomotor skills. In more severe cases, hypotension, respiratory depression, profound sedation, coma, or even death may occur.

MANAGEMENT: Concomitant use of opioid analgesics with ethanol should be avoided.

References

  1. Linnoila M, Hakkinen S. Effects of diazepam and codeine, alone and in combination with alcohol, on simulated driving. Clin Pharmacol Ther. 1974;15:368-73.
  2. Sturner WQ, Garriott JC. Deaths involving propoxyphene: a study of 41 cases over a two-year period. JAMA. 1973;223:1125-30.
  3. Girre C, Hirschhorn M, Bertaux L, et al. Enhancement of propoxyphene bioavailability by ethanol: relation to psychomotor and cognitive function in healthy volunteers. Eur J Clin Pharmacol. 1991;41:147-52.
  4. Levine B, Saady J, Fierro M, Valentour J. A hydromorphone and ethanol fatality. J Forensic Sci. 1984;29:655-9.
  5. Sellers EM, Hamilton CA, Kaplan HL, Degani NC, Foltz RL. Pharmacokinetic interaction of propoxyphene with ethanol. Br J Clin Pharmacol. 1985;19:398-401.
  6. Carson DJ. Fatal dextropropoxyphene poisoning in Northern Ireland. Review of 30 cases. Lancet. 1977;1:894-7.
  7. Rosser WW. The interaction of propoxyphene with other drugs. Can Med Assoc J. 1980;122:149-50.
  8. Edwards C, Gard PR, Handley SL, Hunter M, Whittington RM. Distalgesic and ethanol-impaired function. Lancet. 1982;2:384.
  9. Kiplinger GF, Sokol G, Rodda BE. Effect of combined alcohol and propoxyphene on human performance. Arch Int Pharmacodyn Ther. 1974;212:175-80.
View all 9 references

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Moderate

pseudoephedrine food

Applies to: Maxifed-G CDX (codeine / guaifenesin / pseudoephedrine)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr. Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients. Psychiatry Res. 1979;1:45-52.
  2. Cavanaugh JH, Griffith JD, Oates JA. Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man. Clin Pharmacol Ther. 1970;11:656.
  3. Product Information. Adderall (amphetamine-dextroamphetamine). Shire Richwood Pharmaceutical Company Inc. 2001;PROD.
  4. Product Information. Tenuate (diethylpropion). Aventis Pharmaceuticals. 2001;PROD.
  5. Product Information. Sanorex (mazindol). Novartis Pharmaceuticals. 2001;PROD.
  6. Product Information. Focalin (dexmethylphenidate). Mikart Inc. 2001.
  7. Product Information. Strattera (atomoxetine). Lilly, Eli and Company. 2002.
View all 7 references

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Therapeutic duplication warnings

No duplication warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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