Diamicron/Diamicron MR 60 Drug Interactions

The following substances can increase hypoglycemia: Combination contraindicated: Miconazole (systemic route, oromucosal gel): Increases the hypoglycemic effect with possible onset of hypoglycemic symptoms, or even coma.
Combinations which are not recommended: Phenylbutazone (systemic route): Increases the hypoglycemic effect of sulfonylureas (displaces their binding to plasma proteins and/or reduces their elimination).
It is preferable to use a different anti-inflammatory agent or else warn the patient and emphasize the importance of self-monitoring. Where necessary, adjust the dose during and after treatment with the anti-inflammatory agent.
Alcohol: Consumption of alcoholic drinks and of medicinal products containing alcohol should be avoided.
Increases hypoglycemic reaction (due to inhibition of compensating reactions), that can lead to the onset of hypoglycemic coma.
Diamicron:"Antabuse effect", in particular with chlorpropamide, glibenclamide, glipizide and tolbutamine.
Combinations requiring precautions for use: Potentiation of the blood glucose lowering effect and thus, in some instances, hypoglycemia may occur when one of the following drugs is taken: Other antidiabetic agents (insulin, acarbose, metformin, thiazolidinediones, dipeptidylpeptidase-4 inhibitors, GLP-1 receptor agonists), beta-blockers, fluconazole, angiotensin converting enzyme inhibitor (captopril, enalapril), H2-receptor antagonists, MAOIs, sulfonamides, clarythromycin and non-steroidal anti-inflammatory agents.
The following products may cause an increase in blood glucose levels: Combination which is not recommended: Danazol: diabetogenic effect of danazol.
If the use of this active substance cannot be avoided, warn the patient and emphasize the importance of urine and blood glucose monitoring. It may be necessary to adjust the dose of the antidiabetic agent during and after treatment with danazol.
Combinations requiring precautions during use: Chlorpromazine (neuroleptic agent): High doses (>100 mg per day of chlorpromazine) increase blood glucose levels (reduced insulin release).
Warn the patient and emphasize the importance of blood glucose monitoring. It may be necessary to adjust the dose of the antidiabetic active substance during and after treatment with the neuroleptic agent.
Glucocorticoids (systemic route and local route: intraarticular use, cutaneous or rectal preparations) and tetracosactide: Increase in blood glucose levels with possible ketosis (reduced tolerance to carbohydrates due to glucocorticoids).
Warn the patient and emphasize the importance of blood glucose monitoring, particularly at the start of treatment. It may be necessary to adjust the dose of the antidiabetic active substance during and after treatment with glucocorticoids.
Ritodrine, salbutamol, terbutaline (I.V.): Increased blood glucose levels due to beta-2 agonist effects. Emphasize the importance of monitoring blood glucose levels. If necessary, switch to insulin.
Saint John's Wort (Hypericum perforatum) preparations: Gliclazide exposure is decreased by Saint John's Wort (Hypericum perforatum). Emphasize the importance of blood glucose levels monitoring.
The following products may cause dysglycemia: Combinations requiring precautions during use: Fluoroquinolones: In case of concomitant use of Gliclazide (Diamicron/Diamicron MR 60) and a fluoroquinolone, the patient should be warned of the risk of dysglycemia, and the importance of blood glucose monitoring should be emphasized.
Combinations which must be taken into account: Anticoagulant therapy (warfarin): Sulfonylureas may lead to potentiation of anticoagulation during treatment.
Adjustment of the anticoagulant posology may be necessary.