This document discusses drug interactions related to insulin and oral hypoglycemic drugs. It summarizes that certain drugs can cause hypoglycemia or hyperglycemia when taken with insulin or oral hypoglycemic medications by various mechanisms such as enhancing insulin secretion, inhibiting glucose metabolism, or suppressing insulin release. Specifically, it provides examples of drugs that may cause hypoglycemia, like beta-blockers, salicylates, lithium, and MAO inhibitors when taken with insulin. It also lists drugs that can cause hyperglycemia like thiazide diuretics, corticosteroids, and oral contraceptives.

1. RESEARCH CENTRE
,BIJAPUR
DEPT. OF
PHARMACOLOGY

2. Presented by-Ravi Prakash
ROLL NO.-07M4072

3. DRUG INTERACTIONS
 The effect of one drug on the effectiveness
or toxicity of another drug
or
It occurs when the effect of a particular drug
is altered when it is taken with another
drug or food

4. INSULIN
I.DRUG INTERACTIONS CAUSING
‘HYPOGLYCEMIA’
A. β-adrenergic blockers
 Impair the sympathetic mediated release of glucose from the
liver in response to hypoglycemia
 Decrease adrenergic mediated symptom of hypoglycemia
B. SALICYLATES, LITHIUM andTHEOPHYLLINE
 Enhances insulin secretion and peripheral utilization of glucose
C. MAO INHIBITORS
 Potentiates insulin secretion
 eg. Selegiline,Moclobemide
D. ETHYL ALCOHOL
 Alcohol exerts effect on pancreatic microcirculation by evoking a
massive redistribution of pancreatic blood flow

5. II. DRUGS CAUSING
‘HYPERGLYCEMIA’
A. THIAZIDES
Diuretics K+ depletion
-
Proinsulin Insulin
 Hence it causes inhibition of insulin release and precipitates diabetes
mellitus
B. ADENOCORTICOSTEROIDS
C. ORAL CONTRACEPTIVE PILLS
 Supression of basal level of Cholecystokinin and hence causes decrease in
insulin release
D.SALBUTAMOL
 plasma glucagon level and plasma insulin level
E.NIFEDEPINE

6. ORAL HYPOGLYCEMIC DRUGS
I.SULFONYLUREAS
A . Drugs that cause ‘HYPOGLYCEMIA’: These drugs enhance sulfonylureas
action
1.Induce metabolism of glucose
 Cimetidine
 Acute alcohol intake
 Warfarin
2.Prolong pharmacological action
 Salicylates
 Lithium
 Propanolol
B. DRUGS THAT CAUSE ‘HYPERGLYCEMIA’:These drugs decreases
sulfonylureas action
1.Inhibits metabolism of glucose
 Phenobarbitone
 Phenytoin
 Chronic alcoholism
2. Suppress insulin release
 Corticosteroids
 OC Pills
 Thiazides

7. II. BIGUANIDES
A. Drugs causing ‘HYPOGLYCEMIA’
1. Biguanides along with oral sulfonylureas causes
hypoglycemic effect
2. Phenylbutazone and Sulfaphenazole causes severe
hypoglycemic collapse
3. Biguanides interact with endogenous metals
Zn2+,Cu2+,Fe3+
 Zn2+ causes inhibition of insulin degradation
4. Cimetidine increases metformin plasma concentration by
inhibiting drug metabolising enzyme

8. III.MEGLITINIDE/PHENYLALA
NINE ANALOGUES
A.Drugs that cause ‘HYPOGLYCEMIA’
1.Meglitiniide with metformin causes additive glucose lowering
effect
2.It interacts with α-glucosidase inhibitors decreases
HbA1c,fasting glucose,post prandial glucose levels
3.Some anti hypertensives like ACE inhibitors favour
hypoglycemic action.
B. Drugs that cause ‘HYPERGLYCEMIA’
CYT P4503A4 inhibitors like fluronazole decreases metabolism of
meglitinide

9. IV.α-GLUCOSIDASE
INHIBITORS
1.Increases the levels of sulfonylureas and induce
hypoglycemia
2.Reduce serum digoxin concentration
3. Digestive enzymes and intestinal adsorbents such
as charcoal should not be taken as it decreases
efficiency of α-glucosidase inhibitors

10. DRUG INDUCED
HYPOGLYCEMIA AND
HYPERGLYCEMIA
Drug which causes ‘HYPERGLYCEMIA’
HORMONES
GLUCAGON
Secreted by α-cells of islets of langerhans
Promotes glycogenolysis in liver by stimulating adenyl cyclase enzyme
ESTROGEN
These are group of steroid compounds that diffuses cell membrane and
activate estrogen receptor
THYROID HORMONES
They are required for proper development and differentiation of all cells of
the body regulating metabolism of protein and carbohydrate

11. contd……
OTHER DRUGS
 NICOTINIC ACID
 Acts on G-protein coupled receptors and at
high doses elevates blood sugar level and
thus worsen diabetes mellitus
 PHENYTOIN
 Inhibits insulin release
 THIAZIDES

12. DRUG WHICH CAUSES
‘HYPOGLYCEMIA’
ACE inhibitors
•Prevents nephropathy in diabetes mellitus
•eg. Captopril,Enalapril,Ramipril
Alcohol
•Interferes with the positive effects of oral diabetes medicines
or insulin.
MAO Inhibitors
Lithium
Quinine
Large doses of salicylates

13. HYPOGLYCEMIC EFFECT OF
DRUGS ON VARIOUS ORGANS
DRUGS with
hypoglycemic
effect
PANCREAS LIVER PERIPHERY
Β-adrenergic
antagonist
+ +
Salicylates +
Endomethacin
Ethanol +
Li2+ + +
Ca2+ +
Theophylline +
Sulfonamides
Tetracyclines
Pyridoxine +
MAO inhibitors

14. HYPERGLYCEMIC EFFECT
Drugs causing hyperglycemia PANCREAS LIVER PERIPHERY
Epinephrine + + +
Glucocorticosteroids + +
Diuretics + +
OC Pills + +
Β2 adrenergic agonists + + +
Ca2+ channel blockers +
Phenytoin +
Thiazides +
Clonidine +
H2 receptor blockers +
Morphine +
Heparin

15. REFERENCES
1.Goodman & Gillman
2.Harrison’s Principle of Internal Medicine
3. R.S. Satoskar
4. Rang & Dale
5. KDTripathi
6.Internet

16. THANKING YOU……