C-3.18. Table 13: Select Insulin Drug-Drug Interactions

Target Drug: all insulin products

Interacting Drug Interaction Recommendation Clinical Significance Level
angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs) adjunctive use may increase hypoglycemia risk as ACE inhibitors, ARBS improve insulin sensitivity monitor blood glucose levels and observe for signs/symptoms of hypoglycemia moderate (DrugReax) 3-moderate (CP)
beta blockers combined use may increase or decrease blood glucose levels as beta blockers can alter glucose metabolism; beta blockade may also mask hypoglycemia signs/symptoms monitor patients for signs/ symptoms of hypo- or hyperglycemia with combined therapy; measure blood glucose levels moderate (DrugReax) 3-moderate (CP)
glucagon-like peptide-1 (GLP-1) receptor agonists concurrent use may increase hypoglycemia risk monitor blood glucose levels and consider insulin dose reductions or therapy modification; avoid combination of liraglutide and insulin if liraglutide is used primarily for weight loss liraglutide – major; others – moderate (DrugReax) 2-major (CP)
lithium combined use may increase risk of hypo- or hyperglycemia due to lithium varying effects on glucose metabolism monitor blood glucose levels, especially when adding, discontinuing, modifying therapy moderate (DrugReax) 3-moderate (CP)
metreleptin (Myalept®) concurrent use may increase risk of hypoglycemia use with caution and monitor blood glucose levels closely; potential large decreases in insulin dosage adjustments may be required, or consider therapy modification major (DrugReax) 3-moderate (CP)
peroxisome proliferator-activated receptor (PPAR)-gamma agonists insulin may enhance rosiglitazone, pioglitazone adverse effects (e.g., edema, heart failure); combined use may increase hypoglycemia risk avoid combination with rosiglitazone; if insulin is combined with pioglitazone, consider dose reductions or therapy modification; monitor patients for signs/symptoms of heart failure and hypoglycemia major (DrugReax) 2-major (CP)
pramlintide concurrent use may increase hypoglycemia risk decrease preprandial insulin dose by 50% or consider therapy modification; monitor blood glucose frequently and adjust insulin dose based on glycemic control major (DrugReax) 2-major (CP)
fluoroquinolone antibiotics concomitant use may increase risk of hypo- or hyperglycemia monitor blood glucose levels closely and adjust insulin dose as needed; further insulin dosage adjustments may be required upon fluoroquinolone discontinuation major (DrugReax) 3-moderate (CP)
somatostatin analogs concurrent use may diminish insulin therapeutic effects as somatostatin analogs associated with hyperglycemia monitor blood glucose levels frequently and adjust insulin dose as needed major (DrugReax) 3-moderate (CP)