Interactions : אינטראקציות

7 DRUG INTERACTIONS
Table 6: Clinically Relevant Interactions with XIGDUO XR

Carbonic Anhydrase Inhibitors
Clinical Impact   Topiramate or other carbonic anhydrase inhibitors (e.g., zonisamide, acetazolamide or dichlorphenamide) frequently causes a decrease in serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis. Concomitant use of these drugs with XIGDUO XR may increase the risk for lactic acidosis.
Intervention      Consider more frequent monitoring of these patients.
Drugs that Reduce Metformin Clearance
Table 6: Clinically Relevant Interactions with XIGDUO XR

Clinical Impact      Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2]/multidrug and toxin extrusion [MATE] inhibitors, such as ranolazine, vandetanib, dolutegravir, and cimetidine) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology (12.3)].
Intervention         Consider the benefits and risks of concomitant use.
Alcohol
Clinical Impact      Alcohol is known to potentiate the effect of metformin on lactate metabolism.
Intervention         Warn patients against excessive alcohol intake while receiving XIGDUO XR.
Insulin or Insulin Secretagogues

Clinical Impact      The risk of hypoglycemia may be increased when XIGDUO XR is used concomitantly with insulin or insulin secretagogues (e.g., sulfonylurea) [see Warnings and Precautions (5.5)].

Intervention         Concomitant use may require lower doses of insulin or the insulin secretagogue to reduce the risk of hypoglycemia.

Drugs Affecting Glycemic Control
Clinical Impact   Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control. These medications include thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid.
Intervention      When such drugs are administered to a patient receiving XIGDUO XR, observe the patient closely for loss of blood glucose control. When such drugs are withdrawn from a patient receiving XIGDUO XR, observe the patient closely for hypoglycemia.
Lithium

Clinical             Concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium Impact               concentrations

Intervention         Monitor serum lithium concentration more frequently during XIGDUO XR initiation and dosage changes.

Positive Urine Glucose Test
Clinical Impact    SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests.
Intervention       Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.
Interference with 1,5-anhydroglucitol (1,5-AG) Assay
Clinical Impact    Measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors.
Intervention       Monitoring glycemic control with 1,5-AG assay is not recommended. Use alternative methods to monitor glycemic control.