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| Interactions: | Acarbose
Adverse Effect: An increased risk of hypoglycemia Clinical Management: Monitor closely blood glucose concentrations when Acarbose is added to or withdrawn from Tolbutamide . Dose of either or both drugs may need to be adjusted to minimize hypoglycemic effects. Patients receiving these medications should be counselled to carry a supply of glucose tablets.
Aspirin
Adverse Effect: hypoglycemia (CNS depression, seizures) Clinical Management: During concurrent therapy with tolbutamide and chronic, therapeutic doses of aspirin, monitor blood glucose carefully. Adjustment of the tolbutamide dose may be necessary.
Atenolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Bisoprolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Carvedilol
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Celecoxib
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Celiprolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Chloramphenicol
Adverse Effect: hypoglycemia (CNS depression, seizures) Clinical Management: This combination is not contraindicated, but if chloramphenicol is added to antidiabetic therapy, frequent determinations of serum glucose levels are recommended and dose adjustments should be made if necessary.
Cimetidine
Adverse Effect: hypoglycemia Clinical Management: Concurrent administration of tolbutamide and cimetidine is not recommended. If concurrent use cannot be avoided, monitor the patients blood glucose for signs of hypoglycemia.
Cotrimoxazole
Adverse Effect: Enhanced hypoglycemic effects Clinical Management: Avoid the use of sulfonamide antibiotics and trimethoprim in patients who are taking Tolbutamide . If concomitant therapy is required, closely monitor blood glucose. Emergency treatment of a hypoglycemic episode may be required.
Diclofenac Preps.
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Fluconazole
Adverse Effect: Hypoglycemia (CNS depression, seizures) Clinical Management: During concurrent therapy, monitor blood glucose closely and observe for signs of hypoglycemia.
Flurbiprofen
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Ibuprofen
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Indomethacin
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Insulin Lispro
Adverse Effect: hypoglycemia (CNS depression, seizures) Clinical Management: Monitor blood glucose more aggressively during concurrent use.
Ketoconazole
Adverse Effect: hypoglycemia Clinical Management: Monitor patients for stable blood glucose control, with dose adjustments of the oral hypoglycemic agent as needed.
Ketoprofen
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Ketorolac
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Labetalol
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Lefulnomide
Adverse Effect: Increase in the free fraction of Tolbutamide when both the drugs are administered together # Clinical Management: Monitor for the therapeutic effects and adjust the dosage accordingly.
Mefenamic Acid
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Meloxicam
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Metoprolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Nabumetone
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Nabumetone is coadministered with Tolbutamide , patients should be monitored more closely for hypoglycemia. Dose of Tolbutamide may need to be reduced when Nabumetone is added to therapy.
Naproxen
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Nimesulide
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Oxprenolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Oxyphenbutazone
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Paracetamol
Adverse Effect: A possible increased risk of hypoglycemia Clinical Management: When Paracetamol is coadministered with Tolbutamide , patients should be monitored more closely for hypoglycemia. Doses of Tolbutamide may need to be reduced when Paracetamol is added to therapy.
Phenacetin
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Phenylbutazone
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Phenytoin
Adverse Effect: An increased risk of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremor) Clinical Management: In patients on concurrent phenytoin and tolbutamide therapy, monitor phenytoin serum concentrations and watch patients for signs of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremor).
Pindolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Piroxicam
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy.
Propranolol
Adverse Effect: hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Rifampicin
Adverse Effect: decreased tolbutamide effectiveness Clinical Management: Monitor the patients glucose more closely, during the first two to three weeks of initiating or discontinuing rifampin. A dosage adjustment for tolbutamide may be required.
Selegiline
Adverse Effect: excessive hypoglycemia, CNS depression, and seizures Clinical Management: Blood glucose levels should be closely monitored when Selegiline is added or discontinued in a patient receiving Tolbutamide . Lower dose of Tolbutamide may be required with concomitant therapy.
Sertraline
Adverse Effect: A slight decrease in tolbutamide clearance
Sulphadiazine
Adverse Effect: enhanced hypoglycemic effects Clinical Management: Avoid the use of sulfonamide antibiotics in patients who are taking Tolbutamide . If concomitant use is necessary, closely monitor blood glucose. Emergency treatment of a hypoglycemic episode may be required.
Tenoxicam
Adverse Effect: a possible increased risk of hypoglycemia Clinical Management: When nonsteroidal antiinflammatory agents (NSAIDs) are coadministered with a sulfonylurea drug, patients should be monitored more closely for hypoglycemia. Doses of the sulfonylurea may need to be reduced when NSAIDs are added to therapy |
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