The effect of cholestyramine and activated charcoal on glipizide absorption.

Kivistö, Kari T.; Neuvonen, Pertti J.

doi:10.1111/j.1365-2125.1990.tb03843.x

Cited by 25 publications

(13 citation statements)

References 12 publications

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“…The drug interaction potential for colesevelam is considered low compared to that for conventional BA sequestrants. This is based on the observation that, although many drugs have been shown to interact with the conventional BA sequestrants (eg, fluvastatin, 19 digoxin, 27 warfarin, 28 glipizide, 29 hydrochlorothiazide, 30 propanolol, 31 frusemide, 32 ezetimibe, 33 hydrocortisone, 34 diclofenac, 35 sulindac, 36 and valproate 37 ), pharmacokinetic studies demonstrated that colesevelam does not interact with any of the drugs tested (digoxin, metoprolol, quinidine, valproic acid, warfarin, fenofibrate, lovastatin, and verapamil) 21 – 23 with the possible exception of verapamil. Importantly, this list includes some of the same drugs that did show an interaction with conventional BA sequestrants (ie, digoxin, warfarin, and valproate) 23 .…”

Section: Discussionmentioning

confidence: 99%

Effect of the Bile Acid Sequestrant Colesevelam on the Pharmacokinetics of Pioglitazone, Repaglinide, Estrogen Estradiol, Norethindrone, Levothyroxine, and Glyburide

Brown

Armstrong

Wang

et al. 2010

The Journal of Clinical Pharma

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The purpose of this study was to assess effects of colesevelam on the pharmacokinetics of glyburide, levothyroxine, estrogen estradiol (EE), norethindrone (NET), pioglitazone, and repaglinide in healthy volunteers. Six drugs with a potential to interact with colesevelam were studied in open-label, randomized clinical studies. The presence of a drug interaction was concluded if the 90% confidence intervals for the geometric least squares mean ratios of AUC(0-t) (AUC(0-48) for levothyroxine) and C(max) fell outside the no-effect limits of (80.0%, 125.0%). Concomitant administration of colesevelam had no effect on the AUC(0-t) or C(max) of pioglitazone but significantly decreased the AUC(0-t) and C(max) of glyburide, levothyroxine, and EE and the C(max) of repaglinide and NET. AUC(0-t) and C(max) of glyburide and EE, but not repaglinide or NET, were significantly decreased when the drug was given 1 hour before colesevelam. When glyburide, EE, or levothyroxine was given 4 hours before colesevelam, no drug interaction was observed. Although colesevelam has a cleaner drug interaction profile than other bile acid sequestrants, it does interfere with absorption of some drugs. A 4-hour window appears sufficient to eliminate these interactions.

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Section: Discussionmentioning

confidence: 99%

Effect of the Bile Acid Sequestrant Colesevelam on the Pharmacokinetics of Pioglitazone, Repaglinide, Estrogen Estradiol, Norethindrone, Levothyroxine, and Glyburide

Brown

Armstrong

Wang

et al. 2010

The Journal of Clinical Pharma

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“…A secondary goal is the return of euglycemia in patients who develop hypoglycemia. Patients with recent acute sulfonylurea overdoses should receive activated charcoal if mental status is deemed adequate [13]. Carbohydrate-containing food can be provided to patients if they are awake and alert enough to eat and protect their airway.…”

Section: Clinical Management: Prevention and Initial Management Of Hymentioning

confidence: 99%

Octreotide’s Role in the Management of Sulfonylurea-Induced Hypoglycemia

Dougherty

2010

J. Med. Toxicol.

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The objective is to evaluate the evidence regarding octreotide's efficacy as a treatment for sulfonylurea-induced hypoglycemia. A search of PubMed for articles published from 1965 to 2008 using combinations of the terms octreotide, antidote, sulfonylurea, overdose, poisoning, and toxicity was performed. References from identified articles were reviewed for additional sources. Animal studies, case reports, case series, and randomized controlled trials were evaluated. An animal model of sulfonylurea overdose demonstrates that octreotide reduces the number of refractory sulfonylurea-induced hypoglycemic episodes. Published case reports describe the use of octreotide to prevent recurrent hypoglycemia after sulfonylurea overdose. A retrospective case series demonstrates that administration of octreotide decreases the need for supplemental dextrose boluses as well as hypoglycemic events. Two prospective, controlled trials determined that octreotide and supplemental dextrose increase blood glucose concentrations with fewer hypoglycemic events. Based on animal and human data, there is sufficient evidence to recommend the use of octreotide with supplemental dextrose for the treatment of sulfonylurea-induced hypoglycemia.

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“…Inhibition of glipizide metabolism by trimethoprim-sulfamethoxazole is also assumed, but drug concentrations have not been measured (JOHNSON and DOBMEIER 1990). Intake with cholestyramine reduces glipizide absorption by 29% and with activated charcoal by 81 %, so that the latter may be taken in acute overdose situations (KIVISTÖ and NEUVONEN 1990). As with other sulfonylureas, absorption of glipizide can be enhanced with antacids such as sodium bicarbonate and magnesium hydroxide, but not aluminum hydroxide (KIVISTÖ and NEUVONEN 1991a,b).…”

Section: /) Pharmacokinetic Interactionsmentioning

confidence: 98%