3. 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 pramlintide are summarized in Table 2. 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 | Interacting Drug | Interaction | Recommendation | Clinical Significance Level* |
|---|---|---|---|---|
| antidiabetic agents | fluoroquinolones | adjunctive administration may result in blood glucose disturbances and increased risk for hyper- or hypoglycemia due to an unknown mechanism | closely monitor blood glucose levels and adjust antidiabetic doses as needed; doses may also require adjustments with fluoroquinolone discontinuation | major (DrugReax) 3-moderate (CP) |
| antidiabetic agents | somatostatin analogues (SAs) (e.g., octreotide, pasireotide) | concurrent use may impair glucose regulation as SAs inhibit insulin and glucagon secretion; substantially increased blood glucose levels may result | monitor closely for changes in blood glucose control before and throughout SA therapy; adjust antidiabetic doses as needed | major (DrugReax) 2-major (CP) |
| pramlintide | alpha glucosidase inhibitors (e.g., acarbose, miglitol) | alpha glucosidase inhibitors slow nutritive absorption; adjunctive administration may potentiate pramlintide pharmacologic effects, increasing potential for additional blood glucose reductions and risk of hypoglycemia | concurrent administration not recommended by manufacturer | 3-moderate (CP) |
| pramlintide | gastric stimulants (e.g., metoclopramide, tegaserod) | concurrent administration may attenuate pharmacologic effects of both agents | manufacturer states that pramlintide/gastric stimulant combination should be avoided | 2-major (CP) |
| pramlintide | medications that slow gastrointestinal motility (e.g., tricyclic antidepressants, opiates, antimuscarinics, diphenoxylate) | adjunctive administration may enhance pramlintide pharmacologic effects, increasing potential for additional blood glucose reductions and risk of hypoglycemia | concurrent administration not recommended by manufacturer | 2-major (CP) |
| pramlintide | insulin | adjunctive use may increase hypoglycemia risk; pramlintide pharmacokinetic parameters altered if mixed in same syringe with insulins | reduce mealtime insulin doses to minimize hypoglycemia; do not mix together; give as separate injections | 2-major (CP) |
| pramlintide | oral medications with hypoglycemic effects (e.g., oral antidiabetic agents, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, disopyramide, fibric acid derivatives, salicylates, sulfonamide antibiotics) | concomitant administration may result in enhanced hypoglycemic pharmacologic and adverse effects | monitor blood glucose levels closely and adjust dosages as necessary if drug combination required to minimize excessive hypoglycemia and associated adverse events | moderate (DrugReax) 3-moderate (CP) |
| pramlintide | oral medications with rapid gastrointestinal (GI) absorption, or narrow therapeutic index | pramlintide delays gastric emptying; combined use may reduce serum levels of drugs with narrow therapeutic index, or those requiring rapid GI absorption | use cautiously together | 4-minor (CP) |
| pramlintide | oral medications requiring threshold concentrations for effect (e.g., acetaminophen, oral contraceptives) | concurrent administration may reduce serum levels of drugs with threshold concentrations as pramlintide delays gastric emptying | use cautiously together; administer medications having threshold concentrations for effect at least 1 hour before or 2 hours after pramlintide | 4-minor (CP) |