Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction
The following products are likely to increase the hypoglycaemic effect: - Contraindicated combinations
Miconazole
Increase in hypoglycaemic effect, possibly leading to symptoms of hypoglycaemia or even coma.
- Inadvisable combinations
Nonsteroidal Anti-inflammatory Drugs (e.g. phenylbutazone) Increase in hypoglycaemic effect of sulphonylureas (displacement of sulphonylurea binding to plasma proteins and/or decrease in sulphonylurea elimination).
Alcohol
Increase in hypoglycaemic reaction which can lead to hypoglycaemic coma.
- Combinations requiring precaution
Fluconazole
Increase in the half-life of the sulphonylurea, possibly giving rise to symptoms of hypoglycaemia.
Voriconazole
Although not studied, voriconazole may increase the plasma levels of sulfonylureas, (e.g. tolbutamide, glipizide and glyburide) and therefore cause hypoglycaemia. Careful monitoring of blood glucose is recommended during co- administration.
Salicylates (acetylsalicylic acid)
Increase in hypoglycaemic effect by high doses of acetylsalicylic acid (hypoglycaemic action of the acetylsalicylic acid).
Beta-blockers
All beta-blockers mask some of the symptoms of hypoglycaemia, (i.e. palpitations and tachycardia). Most non cardio selective beta-blockers increase the incidence and severity of hypoglycaemia.
Angiotensin converting Enzyme inhibitors
The use of angiotensin converting enzyme inhibitors may lead to an increased hypoglycaemic effect in diabetic patients treated with sulphonylureas.
Cimetidine
The use of cimetidine may be associated with a reduction in post prandial blood glucose in patients treated with glipizide.
The hypoglycaemic action of sulphonylureas in general may also be potentiated by monoamine oxidase inhibitors, quinolones and drugs that are highly protein bound, such as sulfonamides, chloramphenicol, probenecid, coumarins and fibrates.
When such drugs are administered to (or withdrawn from) a patient receiving glipizide, the patient should be observed closely for hypoglycaemia (or loss of control).
The following products could lead to hyperglycaemia:
- Inadvisable combinations
Danazol
Diabetogenic effect of danazol. If it cannot be avoided, warn the patient and step up self monitoring of blood glucose and urine. Possibly adjust the dosage of antidiabetic agent during treatment with danazol and after its discontinuation.
- Combinations requiring precaution
Colesevelam: In studies assessing the effect of colesevelam on the pharmacokinetics of glipizide in healthy volunteers, reductions in glipizide AUC and Cmax of 12% and 13%, respectively were observed when colesevelam was coadministered with glipizide. When glipizide was administered 4 hours prior to colesevelam, there was no significant change in glipizide AUC or Cmax, -4% and 0%, respectively. Therefore, Gluco-Rite should be administered at least 4 hours prior to colesevelam to ensure that colesevelam does not reduce the absorption of glipizide.
Phenothiazines (e.g. chlorpromazine) at High doses (> 100 mg /day of chlorpromazine)
Elevation in blood glucose (reduction in insulin release).
Corticosteroids
Elevation in blood glucose.
Sympathomimetics (e.g. ritodrine, salbutamol, terbutaline) Elevation in blood glucose due to beta-2-adrenoceptor stimulation.
Progestogens
Diabetogenic effects of high-dose progestogens. Warn the patient and step up self-monitoring of blood glucose and urine. Possibly adjust the dosage of antidiabetic agent during treatment with the neuroleptics, corticoids or progestogen and after discontinuation.
Other drugs that may produce hyperglycaemia and lead to a loss of control include the thiazides and other diuretics, thyroid products, oestrogens, oral contraceptives, phenytoin, nicotinic acid, calcium channel blocking drugs, and isoniazid.
When such drugs are administrated to (or withdrawn from) a patient receiving glipizide, the patient should be observed closely for hypoglycaemia.