OBJECT DRUGS

Antidiabetic Agents:

• Glipizide (Glucotrol, etc.)
• Glyburide (DiaBeta, Glucovance, etc.)

PRECIPITANT DRUGS

Gastric Alkalinizers:

• Antacids
• Cimetidine (Tagamet, etc.)
• Dexlansoprazole (Kapidex)
• Esomeprazole (Nexium, etc.)
• Famotidine (Pepcid, etc.)
• Lansoprazole (Prevacid, etc.)
• Nizatidine (Axid, etc.)
• Omeprazole (Prilosec, etc.)
• Pantoprazole (Protonix, etc.)
• Rabeprazole (Aciphex)
• Ranitidine (Zantac, etc.)

Comment:

Antacids have been reported to increase the rate or amount of absorption of glipizide and glyburide and to increase their hypoglycemic effects. Ranitidine was reported to increase the hypoglycemic effects of glipizide. If these effects are due to changes in gastric pH, other gastric alkalinizers would likely have a similar effect.

Class 3: Assess Risk & Take Action if Necessary

• Circumvent/Minimize: Administration of the glipizide or glyburide two hours before an antacid would avoid the interactions. It may be difficult to separate the doses of an H2-antagonist or PPI to ensure no interaction occurs.
• Consider Alternative: Other oral hypoglycemic agents such as chlorpropamide (Diabinese), metformin (Glucophage), tolbutamide (Orinase), or rosiglitazone (Avandia) may avoid interactions with gastric alkalinizers.
• Monitor: The administration of gastric alkalinizers to patients taking glipizide or glyburide should be accompanied by careful blood glucose monitoring.