OBJECT DRUGS
Antidiabetic Agents: (CYP2C9 Substrates):
- Chlorpropamide (Diabinese)
- Glimepiride (Amaryl)
- Glipizide (Glucotrol, etc.)
- Glyburide (DiaBeta, etc.)
- Nateglinide (Starlix)
- Rosiglitazone (Avandia)
- Tolbutamide (Orinase)
PRECIPITANT DRUGS
Enzyme Inhibitors:
- Amiodarone (Cordarone, etc.)
- Capecitabine (Xeloda)
- Ceritinib (Zykadia)
- Co-trimoxazole (Septra)
- Delavirdine (Rescriptor)
- Efavirenz (Sustiva)
- Etravirine (Intelence)
- Fluorouracil (Adrucil)
- Fluoxetine (Prozac, etc.)
- Fluvastatin (Lescol, etc.)
- Fluvoxamine (Luvox, etc.)
- Metronidazole (Flagyl, etc.)
- Sulfinpyrazone (Anturane)
Comment:
Oral hypoglycemic drugs that are metabolized by CYP2C9 may produce enhanced hypoglycemic effects when administered with a CYP2C9 inhibitor. Nateglinide and rosiglitazone both have additional pathways of metabolism and may be less affected by inhibitors of only one pathway. Co-trimoxazole, however, inhibits two pathways for rosiglitazone metabolism; the trimethoprim component inhibits CYP2C8, and the sulfamethoxazole component inhibits CYP2C9. Single doses of metronidazole would be unlikely to produce hypoglycemia when combined with these antidiabetic agents.
Class 3: Assess Risk & Take Action if Necessary
- Consider Alternative:
- Fluvastatin: Atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor), and simvastatin (Zocor) do not appear to inhibit CYP2C9.
- Fluoxetine / Fluvoxamine: Other SSRI antidepressants would not be expected to interact.
- Monitor: Monitor for hypoglycemic episodes during coadministration of CYP2C9 inhibitors.