Clinically and pharmacologically relevant interactions of antidiabetic drugs

Abstract

Abstract:Patients with type 2 diabetes mellitus often require multifactorial pharmacological treatment due to different comorbidities. An increasing number of concomitantly taken medications elevate the risk of the patient experiencing adverse drug effects or drug interactions. Drug interactions can be divided into pharmacokinetic and pharmacodynamic interactions affecting cytochrome (CYP) enzymes, absorption properties, transporter activities and receptor affinities. Furthermore, nutrition, herbal supplements, patient's age and gender are of clinical importance. Relevant drug interactions are predominantly related to sulfonylureas, thiazolidinediones and glinides. Although metformin has a very low interaction potential, caution is advised when drugs that impair renal function are used concomitantly. With the exception of saxagliptin, dipeptidyl peptidase-4 (DPP-4) inhibitors also show a low interaction potential, but all drugs affecting the drug transporter P-glycoprotein should be used with caution. Incretin mimetics and sodium-glucose cotransporter-2 (SGLT-2) inhibitors comprise a very low interaction potential and are therefore recommended as an ideal combination partner from the clinical-pharmacologic point of view.

Houttuynia cordata extract increased systemic exposure and liver concentrations of metformin through OCTs and MATEs in rats

“…Hyperglycaemia in patients with type 2 diabetes mellitus has been fairly well controlled by antidiabetic therapies, but diabetic complications (e.g., cardiovascular disorders, fatty liver, nephropathy, and neuropathy) and the side effects of antidiabetic agents (e.g., hypoglycaemia, weight gain, and liver and kidney dysfunctions) have been widely reported (Amin & Suksomboon, ; May & Schindler, ; Prabhakar, Kumar, & Doble, ; Stage, Kim, & Christensen, ). These unwanted effects demand the modification or development of suitable alternative antidiabetic treatments, such as combining herbs with antidiabetic drugs, in clinical practice (Prabhakar et al, ).…”

Parkinson';s Disease, Diabetes and Cognitive Impairment

“…The benefit of exenatide lasted 12 months following treatment discontinuation, suggesting that GLP-1 analogues might act on the mechanisms underlying the disease [57]. In terms of adverse effects, exenatide is generally considered to be safe, with a low rate of hypoglycaemic episodes, and few drug interactions [65]. However, in this trial, an increase in L-dopa-induced dyskinesia (LID) was noted in some patients, and required a reduction in L-dopa doses.…”

“…As anticholinergics are commonly used in neurological disease, this may limit the use of metformin in the future. Metformin is also known to reduce vitamin B12 absorption, and this may exacerbate some neurological disease [65]. However, metformin does not cause weight gain or loss, is not associated with hypoglycaemia and is otherwise considered to be a largely safe drug.…”

“…They are prone to liver enzyme inducing and inhibiting drugs, including those commonly seen such as trimethoprim and carbamazepine. This can put the patient at risk, particularly as inhibition of liver metabolism can result in potentially dangerous hypoglycaemic episodes in vulnerable patients [65,75].…”

Disglucemia asociada a fluoroquinolonas: una revisión estructurada

“…correspondencia a: elkyn Johan Granados vega Medellín colombia elkyn.granados@udea.edu.co E n la prevención de la aparición y la progresión de complicaciones crónicas asociadas a la diabetes mellitus y su tratamiento, resulta clave alcanzar y mantener valores de normoglucemia (prepandial: 80-130 mg/dL y postprandial menor 180 mg/dL) y de hemoglobina glicosilada A1 inferiores a 7% 1 . El logro de dicho objetivo en ocasiones se ve afectado por estados de hipoglucemia, atribuidos a las propiedades farmacológicas y mecanismo de acción de los fármacos antidiabéticos, los cuales pueden ser graves y poner en riesgo la vida de los pacientes 2 ; adicionalmente la respuesta de los pacientes al tratamiento con medicamentos antidiabéticos puede verse afectada por interacciones medicamentosas 3 . La medicación concomitante puede causar interacciones farmacocinéticas (cambio en el efecto debido a fluctuaciones en los niveles plasmáticos de los fármacos antidiabéticos) o farmacodinámicas (cambio en el efecto sin variaciones en las concentraciones del antidiabético), generando con ello, estados de hipoglucemia o de hiperglucemia 3,4 , favoreciendo la liberación de insulina, disminuyendo la resistencia periférica a la insulina o reduciendo la producción hepática de glucosa.…”