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Diabetes – Drug-drug Interactions

Drug-drug Interactions

Clinicians should be aware of potential reactions between insulin-sensitizing drugs and antiretroviral agents. For full details, visit the HIV drug interactions website.

Clinicians should also consider overlapping side effects of antiretroviral and other medications with anti-diabetic agents, and the effect of other existing co-morbidities (see the main treatment section).

Summary of drug-drug interactions between antiretroviral and key anti-diabetic medications

The known or potential interactions listed below may require close monitoring, alteration of drug dosage or alteration of timing of administration

  • Insulin has no known or predicted drug-drug interactions with any antiretroviral.
  • Metformin has no known or predicted interactions with protease inhibitors (PIs) or non-nucleoside reverse-transcriptase inhibitors (NNRTIs). No data are available on interactions of metformin with nucleoside reverse transcriptase inhibitors (NRTIs), maraviroc or raltegravir.
  • The sulfonylureas include glibenclamide (glyburide), gliclazide, glipizide and tolbutamide
    • based on their metabolic profiles, these agents have potential interactions with all PIs and NNRTIs1
      • it is predicted that sulfonylureas may show reduced efficacy when co-administered with ritonavir or nelfinavir2
      • it is predicted that increased levels of sulfonylureas may be seen when co-administered with delavirdine2
         
    • glibenclamide has no known or predicted interactions with NRTIs, raltegravir or maraviroc
    • gliclazide has no known or predicted interactions with NRTIs or raltegravir, but potential interaction with maraviroc (based on metabolic profile)
    • for glipizide and tolbutamide, no data are available on interactions with NRTIs, maraviroc or raltegravir
       
  • Pioglitazone, a glitazone or thiazolidinedione, has predicted interactions with all PIs and NNRTIs (based on metabolic profile). Pioglitazone has no known or predicted interactions with NRTIs, maraviroc or raltegravir
    • it is predicted that co-administration of pioglitazone with any PI or delavirdine may lead to increased pioglitazone levels and reduced PI or delavirdine levels2

References

  1. University of Liverpool. The HIV drug interactions website. Accessed 21 March 2011. 
  2. Fichtenbaum CJ, Gerber JG. Interactions between antiretroviral drugs and drugs used for the therapy of the metabolic complications encountered during HIV infection. Clin Pharmacokinet. 2002;41:1195–1211.