4. Drug-Drug Interactions
Patient profiles will be assessed to identify those drug regimens which may result in clinically significant drug-drug interactions. Drug-drug interactions considered clinically relevant for exogenous insulin products are summarized in Table 13. Only those drug-drug interactions identified as clinical significance level 1 or those considered life-threatening which have not yet been classified will be reviewed.
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 (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 (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 | 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 (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 | 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 (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 (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 | 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 | moderate (CP) |