OBJECT DRUGS

Antidiabetic Agents:

• Alogliptin (Nesina)
• Chlorpropamide (Diabinese)
• Glimepiride (Amaryl)
• Glipizide (Glucotrol, etc.)
• Glyburide (DiaBeta, Glucovance, etc.)
• Insulin
• Linagliptin (Tradjenta)
• Metformin (Glucophage, etc.)
• Nateglinide (Starlix)
• Pioglitazone (Actos)
• Repaglinide (Prandin)
• Rosiglitazone (Avandia)
• Saxagliptin (Onglyza)
• Tolbutamide (Orinase)

PRECIPITANT DRUGS

Beta-Blockers, Nonselective:

• Carteolol (Ocupress)
• Carvedilol (Coreg, etc.)
• Labetalol (Trandate)
• Levobunolol (Betagan, etc.)
• Nadolol (Corgard)
• Penbutolol (Levatol)
• Pindolol (Visken)
• Propranolol (Inderal, etc.)
• Sotalol (Betapace, etc.)
• Timolol (Blocadren, etc.)

Comment:

Noncardioselective beta-adrenergic blockers may prolong the duration of a hypoglycemic reaction; patients may also develop hypertensive reactions with compensatory bradycardia during hypoglycemia. All beta-blockers inhibit hypoglycemia-induced tachycardia, but sweating is not inhibited.

Class 2: Use Only if Benefit Felt to Outweigh Risk

• Use Alternative: Avoid nonselective beta-adrenergic blockers in patients receiving antidiabetic agents if possible. If beta-blockers are used, cardioselective agents are preferred, since they are less likely to prolong hypoglycemia or produce hypertensive reactions during hypoglycemia. Cardioselective beta-blockers include acebutolol (Sectral), atenolol (Tenormin), betaxolol (Kerlone), and metoprolol (Lopressor).
• Monitor: Diabetic patients taking beta-blockers should be warned that hypoglycemic episodes may not result in tachycardia.