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Drug Interaction Report
Drug interactions for the following 7 drug(s):

My Interactions List (Unsaved)

fenofibrate

glyburide

hydrochlorothiazide

ibuprofen

lisinopril

metformin

Glucosamine & Chondroitin with MSM (chondroitin / glucosamine / methylsulfonylmethane)

Interactions between your drugs

Moderate
ibuprofen glyburide
Applies to: ibuprofen, glyburide
MONITOR: The hypoglycemic effect of insulin secretagogues (e.g., sulfonylureas, meglitinides) may be potentiated by
certain drugs, including ACE inhibitors, amylin analogs, anabolic steroids, fibrates, monoamine oxidase inhibitors
(MAOIs, including linezolid), nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates, selective serotonin reuptake
inhibitors (SSRIs), sulfonamides, disopyramide, propoxyphene, quinine, quinidine, and ginseng. These drugs may
increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors, fibrates, ginseng); stimulating insulin
secretion (salicylates, NSAIDs, disopyramide, quinine, quinidine, MAOIs, ginseng); increasing peripheral glucose
utilization (SSRIs, insulin-like growth factor); inhibiting gluconeogenesis (SSRIs, MAOIs, insulin-like growth factor);
slowing the rate of gastric emptying (amylin analogs); and/or suppressing postprandial glucagon secretion (amylin
analogs). Or, they may increase plasma concentration of insulin secretagogues by displacing them from plasma
protein binding sites and/or inhibiting their metabolism (fibrates, NSAIDs, salicylates, sulfonamides). Clinical
hypoglycemia has been reported during use of some of these agents alone or with insulin and/or sulfonylureas. Use of
SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases.

MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are
coadministered with insulin secretagogues, particularly in patients with advanced age and/or renal impairment. The
oral antidiabetic dosage(s) may require adjustment if an interaction is suspected. Patients should be apprised of the
signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness,
sweating, palpitations), how to treat it, and to contact their doctor if it occurs. Patients should be observed for loss of
glycemic control when these drugs are withdrawn.

References
1. Christensen LK, Hansen JM, Kristensen M "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics." Lancet 2 (1963):
1298-301
2. Turtle JR, Burgess JA "Hypoglycemic action of fenfluramine in diabetes mellitus." Diabetes 22 (1973): 858-67
3. Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L.)
with a depressed ginsenoside profile does not affect postprandial glycemia." Eur J Clin Nutr 57 (2003): 243-8

View all 101 references

1 dari 7 04/03/2018 12:36

. References 1." Am J Clin Nutr 65 (1997): S678-81 3. Carrara MC "On the mechanism of the hyperglycaemic effect of chlorpromazine. omacetaxine. Romero JC. danazol. and the dosages of concomitant antidiabetic agents adjusted as necessary. NSAIDs may also increase the risk of hyperkalemia associated with potassium-sparing diuretics. Jori A. temsirolimus. At the same time. "Product Information. on insulin secretion." Mayo Clin Proc 57 (1982): 289-96 2.com/interactions-check. Amaryl (glimepiride)." J Pharm Pharmacol 18 (1966): 623-4 2. These drugs may interfere with blood glucose control because they can cause hyperglycemia.. human growth hormone. Muller FO. Ribes G. McCarthy JT. Natriuretic and diuretic effects may also be reduced. as NSAIDs have been reported to cause sodium and water retention.000 person-years in patients on diuretics to 23. consequently. Likewise. MANAGEMENT: Caution is advised when drugs that can interfere with glucose metabolism are prescribed to patients with diabetes. gonadotropin-releasing hormone agonists. which may account for the increased risk of congestive heart failure associated with the combination. Buys D. estrogens.php?drug_list=1071-0. isoniazid. The risk may be increased in patients on dietary sodium restriction. phenytoin. protease inhibitors. both drugs should be discontinued until the condition is corrected. corticosteroids.1185. Kansas City. LN 5330. Bennett WM "Drug interactions and consequences of sodium restriction. View all 83 references 2 dari 7 04/03/2018 12:36 . One study showed an increase in the incidence density of congestive heart failure (in patients over 55 years of age) from 9.3 per 1. hypotensive effect of the diuretics may be reduced because inhibition of prostaglandins can lead to unopposed pressor activity and. glucose intolerance. diuretics." Eur J Clin Pharmacol 48 (1995): 247-51 View all 26 references Moderate glyburide hydrochlorothiazide Applies to: glyburide. progestins. hydrochlorothiazide MONITOR: Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics may adversely affect renal function due to NSAID inhibition of the renal synthesis of prostaglandins that help maintain renal perfusion in dehydrated states. as well as pharmacologic dosages of nicotinic acid and adrenocorticotropic agents. Close clinical monitoring of glycemic control is recommended following initiation or discontinuation of these drugs. MANAGEMENT: In patients receiving both diuretic and NSAID therapy.000 person-years in patients on both diuretic and NSAID therapy. If renal insufficiency or hyperkalemia develops. Moderate ibuprofen hydrochlorothiazide Applies to: ibuprofen. Schall R. phenothiazines. patients should be observed for hypoglycemia when these drugs are withdrawn from their therapeutic regimen. Blayac JP. management consists of avoiding dehydration and carefully monitoring the patient's renal function and blood pressure. Devaal AC. elevation in blood pressure. asparaginase. Hundt HKL. thyroid hormones. et al "Acute intrinsic renal failure induced by indomethacin. Loubatieres-Mariani MM "Effects of a new benzothiadiazine derivative. Groenewoud G." Hoechst Marion-Roussel Inc. Torres VE. diazoxide. Patients should be advised to notify their physician if their blood glucose is consistently high or if they experience symptoms of severe hyperglycemia such as excessive thirst and increases in the volume or frequency of urination. MO. References 1.3 per 1. Puech R. new-onset diabetes mellitus. hydrochlorothiazide MONITOR: The efficacy of insulin and other antidiabetic agents may be diminished by certain drugs.com Print Version https://www. Middle MV "Influence of meloxicam on furosemide pharmacokinetics and pharmacodynamics in healthy volunteers. megestrol. sympathomimetic amines." Arch Int Pharmacodyn Ther 253 (1981): 154-63 3. and/or exacerbation of preexisting diabetes. pegaspargase. copanlisib.drugs.Drugs. including atypical antipsychotics.

ACE inhibitors can further worsen renal function by blocking the effect of angiotensin II-mediated efferent arteriolar vasoconstriction. tremor. References 1. anabolic steroids. sulfonylureas. which results in unopposed pressor activity producing hypertension. low-dose aspirin) or intermittent short-term administration of NSAIDs. and renal failure. quinidine. selective serotonin reuptake inhibitors (SSRIs). including elevations in serum creatinine and BUN. ibuprofen lisinopril Applies to: ibuprofen. inhibiting gluconeogenesis (SSRIs. MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin secretagogues. Ahmad S "Indomethacin-enalapril interaction: an alert. Templ H "Acute hypotensive effect of captopril in man modified by prostaglandin synthesis inhibition.. dizziness.com Print Version https://www. which also affects blood pressure. nephrotic syndrome. Townend JN. stimulating insulin secretion (salicylates. MAOIs. and to contact their doctor if it occurs.g. sulfonamides. slowing the rate of gastric emptying (amylin analogs).Drugs. glomerulitis. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases. Acute renal failure may occur. fibrates. Or.php?drug_list=1071-0.com/interactions-check. ginseng). Stanek B. In addition." Br Heart J 73 (1995): 434-41 2. Doran J. meglitinides) may be potentiated by certain drugs. quinine. propoxyphene. MONITOR: Concomitant use of NSAIDs and ACE inhibitors may cause deterioration in renal function. lisinopril MONITOR: The hypoglycemic effect of insulin secretagogues (e.g. sulfonamides). quinidine. thereby decreasing glomerular filtration. or change of dosage of the NSAID. nausea. hunger. The oral antidiabetic dosage(s) may require adjustment if an interaction is suspected. ginseng). insulin-like growth factor). in patients with prerenal conditions whose renal perfusion may be dependent on the function of prostaglandins. Additionally. sweating. Lote CJ. quinine. disopyramide. disopyramide. Patients should be observed for loss of 3 dari 7 04/03/2018 12:36 . acute interstitial nephritis. lisinopril MONITOR: Nonsteroidal anti-inflammatory drugs (NSAIDs) may attenuate the antihypertensive effects of ACE inhibitors.1185. MANAGEMENT: Patients receiving ACE inhibitors who require prolonged (greater than 1 week) concomitant therapy with an NSAID should have blood pressure monitored more closely following initiation. NSAIDs can cause fluid retention. headache. particularly in patients who are elderly or volume-depleted (including those on diuretic therapy) or have compromised renal function.. Renal function should also be evaluated periodically during prolonged coadministration. salicylates. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors." Br J Clin Pharmacol 14 (1982): s87-93 3. MAOIs. including linezolid). fibrates. and/or suppressing postprandial glucagon secretion (amylin analogs). NSAIDs. renal papillary necrosis. monoamine oxidase inhibitors (MAOIs. nonsteroidal anti-inflammatory drugs (NSAIDs). insulin-like growth factor). The interaction is not expected to occur with low doses (e.drugs. Davies MK "Peripheral haemodynamic effects of inhibition of prostaglandin synthesis in congestive heart failure and interactions with captopril. they may increase plasma concentration of insulin secretagogues by displacing them from plasma protein binding sites and/or inhibiting their metabolism (fibrates. particularly in patients with advanced age and/or renal impairment. NSAIDs may precipitate overt renal decompensation via a dose-related inhibition of prostaglandin synthesis. Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or sulfonylureas. palpitations). how to treat it. salicylates. Some NSAIDs may also alter the pharmacokinetics of certain ACE inhibitors.. tubular necrosis.. Chronic use of NSAIDs alone may be associated with renal toxicities. Silberbauer K. NSAIDs.g. amylin analogs. although effects are usually reversible. The proposed mechanism is NSAID-induced inhibition of renal prostaglandin synthesis. drowsiness. discontinuation. including ACE inhibitors. and ginseng." South Med J 84 (1991): 411-2 View all 13 references Moderate glyburide lisinopril Applies to: glyburide. For example. weakness. increasing peripheral glucose utilization (SSRIs. oxaprozin has been shown to reduce the systemic exposure (AUC) of enalapril and its active metabolite.. Patients should be apprised of the signs and symptoms of hypoglycemia (e. enalaprilat.

glucose intolerance. Some patients on diuretics.com Print Version https://www. especially those on dialysis or a dietary salt restriction." Astra Pharmaceuticals. Sievenpiper JL.com/interactions-check. View all 23 references Moderate hydrochlorothiazide metformin Applies to: hydrochlorothiazide. Alternatively. may experience acute hypotension with lightheadedness and dizziness after receiving the first dose of the ACE inhibitor." Br Med J 288 (1984): 844-5 2. the patient may remain under medical supervision for at least two hours after the first dose of the ACE inhibitor. new-onset diabetes mellitus. electrolytes. MANAGEMENT: Monitoring of blood pressure. Whitworth JA.1185. glycemic control when these drugs are withdrawn. diuresis. Burgess JA "Hypoglycemic action of fenfluramine in diabetes mellitus." Circulation 90 (1994): 220-4 3. References 1. Good JM. References 4 dari 7 04/03/2018 12:36 . Brady AJ. thiazides and other diuretics may interfere with glucose control by causing hyperglycemia.drugs. Leiter LA. Wayne. Likewise.. Some ACE inhibitors may attenuate the increase in the urinary excretion of sodium caused by some loop diuretics. slow or irregular heartbeat. References 1. Lexxel (enalapril-felodipine). ACE inhibitors may cause renal insufficiency or acute renal failure in patients with sodium depletion or renal artery stenosis. Cleland JG "Effect of intense angiotensin II suppression on the diuretic response to furosemide during chronic ACE inhibition. Kristensen M "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics. Vuksan V "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L. In addition. Kincaid-Smith P "Renal insufficiency with combinations of angiotensin converting enzyme inhibitors and diuretics." Lancet 2 (1963): 1298-301 2. abdominal upset) or loss of glycemic control." Diabetes 22 (1973): 858-67 3. Noormohamed FH.. diuretics and angiotensin converting enzyme (ACE) inhibitors may have additive effects. somnolence. Murphy BF. Dose adjustments of metformin may be required. Turtle JR. Patients should be advised to monitor their blood glucose and to promptly notify their doctor if they experience possible signs of lactic acidosis (such as malaise. Arnason JT. hyperventilation. or either discontinuing the diuretic temporarily or increasing the salt intake approximately one week prior to initiating an ACE inhibitor. Coadministration makes hypotension and hypovolemia more likely than does either drug alone.Drugs. Christensen LK. PA. respiratory distress. and renal function is recommended during coadministration. Oakley CM. MANAGEMENT: Close clinical monitoring is recommended if diuretics are coadministered with antidiabetic agents." Eur J Clin Nutr 57 (2003): 243-8 View all 101 references Moderate hydrochlorothiazide lisinopril Applies to: hydrochlorothiazide. lisinopril MONITOR: Although they are frequently combined in clinical practice. and/or exacerbation of preexisting diabetes. or until blood pressure has stabilized. patients should be observed for hypoglycemia if diuretics are withdrawn from their therapeutic regimen. The possibility of first-dose hypotensive effects may be minimized by initiating therapy with small doses of the ACE inhibitor. In addition. "Product Information. Hansen JM. metformin MONITOR: Diuretic-induced renal impairment and dehydration may increase the risk of lactic acidosis in patients who are concomitantly taking metformin.php?drug_list=1071-0. myalgia.) with a depressed ginsenoside profile does not affect postprandial glycemia.

stimulating insulin secretion (salicylates. insulin-like growth factor).1185. drowsiness. particularly in patients with advanced age and/or renal impairment. slowing the rate of gastric emptying (amylin analogs). Symptomatic and sometimes severe hypoglycemia has occurred." O 0 2. The mechanism is unknown. MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if ACE inhibitors are coadministered with metformin. drowsiness. and to contact their doctor if it occurs.Drugs. Leiter LA. "Multum Information Services. how to treat it. selective serotonin reuptake inhibitors (SSRIs)." Hoechst Marion-Roussel Inc. weakness. Hansen JM. sulfonylureas. tremor. Christensen LK. nausea. sweating. increasing peripheral glucose utilization (SSRIs. sweating. Expert Review Panel" View all 4 references Moderate lisinopril metformin Applies to: lisinopril. NSAIDs. References 1. salicylates.com Print Version https://www. hunger. how to treat it. meglitinides) may be potentiated by certain drugs. headache. and/or suppressing postprandial glucagon secretion (amylin analogs). dizziness. Patients should be observed for loss of glycemic control when ACE inhibitors are withdrawn. particularly in patients with advanced age and/or renal impairment. "Product Information. 1. including linezolid). quinine. headache. Patients should be apprised of the signs and symptoms of hypoglycemia (e. nonsteroidal anti-inflammatory drugs (NSAIDs). amylin analogs. Moderate glyburide fenofibrate Applies to: glyburide. Altace (ramipril). MAOIs. palpitations). inhibiting gluconeogenesis (SSRIs. fibrates..php?drug_list=1071-0. including ACE inhibitors. Cerner Multum.g. Arnason JT. disopyramide. tremor. fibrates. Cerner Multum. salicylates. weakness. dizziness." Eur J Clin Nutr 57 (2003): 243-8 5 dari 7 04/03/2018 12:36 . Inc. hunger. ginseng). anabolic steroids.com/interactions-check. Kansas City. including metformin. Patients should be apprised of the signs and symptoms of hypoglycemia (e. quinidine. monoamine oxidase inhibitors (MAOIs. Burgess JA "Hypoglycemic action of fenfluramine in diabetes mellitus. they may increase plasma concentration of insulin secretagogues by displacing them from plasma protein binding sites and/or inhibiting their metabolism (fibrates. NSAIDs. insulin-like growth factor). disopyramide. fenofibrate MONITOR: The hypoglycemic effect of insulin secretagogues (e. MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin secretagogues.g. and to contact their physician if it occurs. propoxyphene.drugs. Clinical hypoglycemia has been reported during use of some of these agents alone or with insulin and/or sulfonylureas. "Australian Product Information. Inc. "UK Summary of Product Characteristics. quinidine. Inc.. sulfonamides. metformin MONITOR: Limited data suggest that ACE inhibitors may potentiate the hypoglycemic effects of oral antidiabetic drugs." Lancet 2 (1963): 1298-301 2. These drugs may increase the risk of hypoglycemia by enhancing insulin sensitivity (ACE inhibitors. and ginseng. References 1. Turtle JR. MO.. Kristensen M "Sulphaphenazole-induced hypoglycemic attacks in tolbutamide-treated diabetics." Diabetes 22 (1973): 858-67 3. palpitations). Or.) with a depressed ginsenoside profile does not affect postprandial glycemia. Sievenpiper JL. The oral antidiabetic dosage(s) may require adjustment if an interaction is suspected.g. nausea. Dosage adjustments may be required if an interaction is suspected. Patients should be observed for loss of glycemic control when these drugs are withdrawn.. ginseng). Vuksan V "Variable effects of American ginseng: a batch of American ginseng (Panax quinquefolius L." O 0 3. Use of SSRIs has also been associated with loss of awareness of hypoglycemia in isolated cases.. MAOIs. sulfonamides). quinine.

Note: this does not necessarily mean no interactions exist. Ray K. Moderate Moderately clinically significant. MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. take steps to circumvent the interaction risk and/or institute a monitoring plan. Good CB. West Point. Glucosamine & Chondroitin with MSM (chondroitin / glucosamine / methylsulfonylmethane) interacts with 6 other drugs. 3. In some cases. Drug Interaction Classification The classifications below are a guideline only. Unknown No information available.php?drug_list=1071-0. assess risk and consider an alternative drug.drugs." JAMA 274 (1995): 538 Therapeutic duplication warnings No therapeutic duplications were found for your selected drugs.com/interactions-check. Inc. Usually avoid combinations. use it only under special circumstances. Minimize risk.1185. References 1. the risk of the interaction outweighs the benefit. McDermott L "Diet and serum potassium in patients on ACE inhibitors. ibuprofen interacts with more than 200 other drugs and more than 10 diseases. Always consult with your doctor or pharmacist. Dorman S. "Product Information. Do not stop taking any medications without consulting your healthcare provider. metformin interacts with more than 200 other drugs and 4 diseases.Drugs. PA. Other drug and disease interactions fenofibrate interacts with more than 60 other drugs and 7 diseases. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system. hydrochlorothiazide interacts with more than 400 other drugs and more than 10 diseases. Major Highly clinically significant.com Print Version https://www. Drug and food interactions Moderate lisinopril food Applies to: lisinopril GENERALLY AVOID: Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. affected patients were using a potassium-rich salt substitute." Merck & Co. lisinopril interacts with more than 300 other drugs and 8 diseases. Minor Minimally clinically significant.. Watson R "Severe hyperkalaemia due to the concomitant use of salt substitutes and ACE inhibitors in hypertension: a potentially life threatening interaction. Avoid combinations.. View all 101 references No other interactions were found between your selected drugs. Particular attention should be paid to the potassium content of salt substitutes. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply. glyburide interacts with more than 400 other drugs and 6 diseases." J Hum Hypertens 13 (1999): 717-20 2. Vasotec (enalapril). 6 dari 7 04/03/2018 12:36 .

The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe. This material does not endorse drugs. Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate.Drugs. skill. or recommend therapy. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Inc.php?drug_list=1071-0. Copyright 2000-2018 Multum Information Services. the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. Multum Information Services.1185. In addition. or appropriate for any given patient. 7 dari 7 04/03/2018 12:36 . check with your doctor. up-to-date and complete. but no guarantee is made to that effect. If you have questions about the drugs you are taking.drugs. the expertise. allergic reactions. or adverse effects. or pharmacist. precautions. directions.. and not a substitute for. drug interactions. nurse.com Print Version https://www.com/interactions-check. warnings.. diagnose patients. Multum's information is a reference resource designed as supplement to. and judgement of healthcare practitioners in patient care. Inc. The information contained herein is not intended to cover all possible uses. knowledge. effective.