The following products are likely to increase the risk of hypoglycaemia: Contraindicated Combination: Miconazole (systemic route, oromucosal gel): Increases the hypoglycaemic effect with possible onset of hypoglycaemic symptoms or even coma.
Combinations Which are Not Recommended: Phenylbutazone (Systemic Route): Increases the hypoglycemic effect of sulfonylurea (displaces their binding to plasma proteins and/or reduces their elimination).
It is preferable to use a different anti-inflammatory agent or else to warn the patient and emphasize the importance of self-monitoring. Where necessary, adjust the dose during and after treatment with the anti-inflammatory agent.
Alcohol: Increases the hypoglycaemic reaction (by inhibiting compensatory reactions) that can lead to the onset of hypoglycaemic coma.
Alcohol or medicinal products containing alcohol should be avoided.
Combinations Requiring Precautions for Use: Potentiation of the blood glucose-lowering effect and thus, in some instances, hypoglycaemia may occur when one of the following drugs is taken eg: Other antidiabetic agents (insulins, acarbose, biguanides), β-blockers, fluconazole, angiotensin-converting enzyme inhibitors (captopril, enalapril), H2-receptor antagonists, MAOIs, sulfonamides and nonsteroidal anti-inflammatory agents.
The following products may cause an increase in blood glucose levels: Combination Which is Not Recommended: Danazol: Diabetogenic effect of danazol. If the use of this active substance cannot be avoided, warn the patient and emphasize the importance of urine and blood glucose monitoring. It may be necessary to adjust the dose of the antidiabetic agent during and after treatment with danazol.
Combinations Requiring Precautions During Use: Chlorpromazine (Neuroleptic Agent): High doses (>100 mg/day of chlorpromazine) increase blood glucose levels (reduced insulin release).
Warn the patient and emphasize the importance of blood glucose monitoring. It may be necessary to adjust the dose of the antidiabetic active substance during and after treatment with the neuroleptic agent.
Glucocorticoids (Systemic and Local Route: Intra-Articular, Cutaneous and Rectal Preparations) and Tetracosactrin: Increase in blood glucose levels with possible ketosis (reduced tolerance to carbohydrates due to glucocorticoids).
Warn the patient and emphasize the importance of blood glucose monitoring, particularly at the start of treatment. It may be necessary to adjust the dose of the antidiabetic active substance during and after treatment with glucocorticoids.
Ritodrine, Salbutamol, Terbutaline (IV): Increased blood glucose levels due to β2-agonist effects.
Emphasize the importance of monitoring blood glucose levels. If necessary, switch to insulin.
Combination Which Must be Taken Into Account: Anticoagulant Therapy (eg, Warfarin): Sulfonylureas may lead to potentiation of anticoagulation during concurrent treatment. Adjustment of the anticoagulant may be necessary.