Diabetes Clinic

______________• Drugs that Can Cause Hyperglycemia
______________• Drugs that Can Cause Hypoglycemia
______________• Drugs that Can Mask Hypoglycemia
______________• MEDICATIONS THAT INTERACT WITH DIABETES MEDICATION:
________________________________________- Medications that can interfere with pioglitazone (Actos)
________________________________________- Medications that can interfere with rosiglitazone (Avandia)
________________________________________- Medications that can interfere with metformin (Glucophage)

When looking at drugs that may affect glucose levels, we need to invoke some special rules. There are medicines that can cause hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) in diabetic and in nondiabetic patients. These pharmaceuticals will have an even greater effect on the patient with diabetes and should either be avoided or used with vigilance and with a consideration of changing the amount of the diabetes medication used.

Some medications are found to have a possible effect on the patient with diabetes but can be used more freely. Again, however, vigilance is warranted.

There is also a category of medications that interact with diabetes medications. These medications don’t actually cause hypoglycemia or hyperglycemia, but rather they interfere with the action of the medicines you are taking for your diabetes. Whenever you start a new medication, it’s important to understand if it will affect your blood sugars or interfere with your blood sugar medication. In either case, it is important to monitor your glucose levels carefully.

Some products listed below consist of two medications combined in the same pill. These are shown with a plus sign (+) between the two medications. Only generic names are used in the following lists. Your pharmacist will be able to tell you the brand names or generic names of medications you use. Due to the aggressive reporting requirements of the FDA, new contraindication information is constantly becoming available. Check with your pharmacist on a regular basis. And remember: If you have any questions about how your medicines can affect your blood sugars, be sure to ask your physician or pharmacist.

Drugs That Can Cause Hyperglycemia
Most Likely		Less Likely
Acitretin Amprenavir Atenolol + chlorthalidone Benazepril + hydrochlorothiazide Bisoprolol + hydrochlorothiazide Bumetanide Candesartan + hydrochlorothiazide Captopril + hydrochlorothiazide Chlorothiazide Chlorthalidone Corticotropin (ACTH) Cortisone Dexamethasone Enalapril + hydrochlorothiazide Ethacrynic acid Fosinopril + hydrochlorothiazide Furosemide Hydrochlorothiazide Hydrochlorothiazide + irbesartan Hydrochlorothiazide + lisinopril Hydrochlorothiazide + losartan	Hydrochlorothiazide + metoprolol Hydrochlorothiazide + moexipril Hydrochlorothiazide + quinapril Hydrochlorothiazide + telmisartan Hydrochlorothiazide + valsartan Hydrocortisone Indapamide Indinavir Lopinavir + ritonavir Megestrol Metolazone Nelfinavir Pentamidine Ritonavir Saquinavir Tacrolimus Torsemide	Abacavir Abacavir + lamivudine, zidovudine Acetazolamide Albuterol, levalbuterol Albuterol + ipratropium Ammonium chloride Amphotericin B Amphotericin B lipid formulations Arsenic trioxide Atovaquone Baclofen Betamethasone Betamethasone + clotrimazole Betaxolol Bexarotene Bicalutamide Caffeine Carteolol Carvedilol Chlorothiazide Choline salicylate Choline salicylate + magnesium salicylate Clobetasol Clozapine Conjugated estrogens Conjugated estrogens + medroxyprogesterone Cyclosporine Daclizumab Desonide Desoximetasone Dextromethorphan + promethazine Diazoxide Encainide Esterified estrogens, estrone, estropipate Esterified estrogens + methyltestosterone Estradiol, ethinyl estradiol Estradiol + norethindrone Estradiol + norgestimate Estramustine Fluoxetine	Flurandrenolide Formoterol Gatifloxacin Gemtuzumab ozogamicin Interferon alfa-2a Interferon alfa-2b Interferon alfa-2b + ribavirin Interferon alfa-n1 Irinotecan Isoniazid Isotretinoin Lamivudine L-asparaginase Levonorgestrel Magnesium salicylate Medroxyprogesterone Methylprednisolone Metoprolol Modafinil Moxifloxacin Mycophenolate Nadolol Niacin, niacinamide Nilutamide Nitric oxide Norethindrone Norgestrel Nystatin Nystatin + triamcinolone Octreotide Pantoprazole Pegaspargase Peginterferon alfa-2b Phenytoin Pipecuronium Prednisolone Prednisone Progesterone Ritodrine Rituximab Salmeterol Salsalate Sodium oxybate Somatropin Sotalol Streptozocin Triamcinolone Ursodeoxycholic acid, ursodiol Valproic acid, divalproex sodium
Drugs That Can Cause Hypoglycemia
Most Likely	Less Likely
Alcohol Diazoxide Dicumarol Dorzolamide + timolol Fosphenytoin Glimepiride Glipizide Glyburide Glyburide + metformin Penicillamine Pentamidine Phenytoin Quinine	Acebutolol Acebutolol Acetohexamide Amphotericin B Amphotericin B lipid formulations Aspirin Aspirin + dipyridamole Atenolol Atenolol + chlorthalidone Betaxolol Bisoprolol Bisoprolol + hydrochlorothiazide Choline salicylate	Choline salicylate + magnesium salicylate Chromium Clarithromycin Dalfopristin + quinupristin Disopyramide Fluoxetine Gatifloxacin Ginseng, panax ginseng Horse chestnut (Aesculus hippocastanum) Hydrochlorothiazide + metoprolol Interferon beta-1b Levofloxacin Magnesium salicylate Metoprolol	Nadolol Octreotide Pindolol Ritodrine Rituximab Rosiglitazone Salicylates Salsalate Sodium ferric gluconate complex Somatropin Sotalol Streptozocin Sulfadiazine Tacrolimus Timolol Tolazamide Tolbutamide
Drugs That Can Mask Hypoglycemia
Carteolol Carvedilol Propranolol
MEDICATIONS THAT INTERACT WITH DIABETES MEDICATION
Medications that can interfere with pioglitazone (Actos)	Medications that can interfere with rosiglitazone (Avandia)	Medications that can interfere with metformin (Glucophage)
Alosetron Alprazolam Astemizole Bexarotene Carbamazepine Cisapride Cyclosporine Diazepam Diltiazem Erythromycin Estradiol + norethindrone Estradiol + norgestimate Felodipine Fexofenadine Galantamine Glyburide Itraconazole Levonorgestrel Megestrol Metformin Midazolam Nifedipine Norethindrone Norgestrel Quinidine Reboxetine Simvastatin Terfenadine Trandolapril + verapamil Triazolam Trimetrexate Verapamil	Alfentanil Alprazolam Astemizole Atorvastatin Bexarotene Carbamazepine Citalopram Conjugated estrogens Cyclosporine Docetaxel Donepezil Esterified estrogens, estrone, estropipate Esterified estrogens + methyltestosterone Estradiol, ethinyl estradiol Estradiol + norethindrone Estradiol + norgestimate Fentanyl Galantamine Glyburide + metformin Leflunomide Levonorgestrel Medroxyprogesterone Megestrol Montelukast Norethindrone Norgestrel Paclitaxel Reboxetine Repaglinide Riluzole Sildenafil Tamoxifen Terfenadine Warfarin Ziprasidone	Amiloride Cimetidine Cyanocobalamin (vitamin B-12) Digoxin Dofetilide Famotidine Furosemide Midodrine Morphine Nifedipine Nizatidine Procainamide Propantheline Quinidine Quinine Ranitidine Repaglinide Sulfamethoxazole + trimethoprim Trimethoprim Vancomycin