First, sulfonylurea hypoglycemic agents
Application principles and precautions:
(1) This kind of drugs should be taken from a small dosage, and the dosage should be gradually increased as needed, and the effect is good before meals.
(2) Short-acting sulfonylurea hypoglycemic agents should be selected for elderly diabetic patients and patients with high postprandial blood sugar; Long-acting sulfonylurea hypoglycemic agents should be selected for patients with type 2 diabetes with long course of disease and high fasting blood sugar.
(3) This drug can cause weight gain. Improper use can lead to hypoglycemia, especially in elderly patients and those with liver and renal insufficiency.
(4) Diet should be controlled while using this kind of drugs, otherwise the curative effect will be poor.
(5) When sulfonylureas are used alone to control the blood sugar below the standard, biguanides, α -glucosidase inhibitors, insulin and thiazolidinediones can be combined. Generally, the same patient does not use two sulfonylureas at the same time.
(6) Pay attention to the interaction between sulfonylureas and other drugs:
Interacting drugs
Action result
Ethanol, cimetidine, chloramphenicol, fluconazole, sulfonamides, coumarin anticoagulants.
Delaying the metabolism of hypoglycemic drugs and increasing the hypoglycemic effect
Salicylates, fibrates, dicoumarin anticoagulants.
Competing with hypoglycemic agents and combining with protein to increase hypoglycemic effect.
Quinidine, guanethidine, insulin, monoamine oxidase inhibitors and other oral hypoglycemic drugs.
It has hypoglycemic effect and increases hypoglycemic effect.
Beta receptor blocker
Increase the risk of hypoglycemia, cover up the symptoms of hypoglycemia, and the combination can enhance the adverse reactions.
Glucocorticoids, thiazide diuretics, rifampicin, phenytoin sodium, estrogen.
Weakening the hypoglycemic effect of this product is easy to produce hyperglycemia, so the dosage needs to be adjusted.
Second, glinide hypoglycemic agents
Application principles and precautions:
(1) is suitable for patients with type 2 diabetes whose postprandial blood sugar is mainly increased, or for patients with type 2 diabetes who still have a certain secretory function of islet β cells when combined with long-acting insulin.
(2) Take it orally immediately before meals, and do not take medicine when not eating.
(3) The metabolism time of these drugs in vivo is short, and they can also be used for patients with mild to moderate liver and renal insufficiency.
(4) The main adverse reactions are hypoglycemia, gastrointestinal dysfunction, and allergic reactions and elevated liver enzymes are rare.
(5) Interaction between glinides and other drugs:
Interacting drugs
Action result
melbine
Combined use can enhance the hypoglycemic effect and increase the risk of hypoglycemia.
Monoamine oxidase inhibitors, non-selective beta blockers, non-steroidal anti-inflammatory drugs, salicylic acids, octreotide, ethanol.
Combined use can enhance the hypoglycemic effect and increase the risk of hypoglycemia.
Thyroid preparations, contraceptives, sympathomimetic drugs, thiazide diuretics, glucocorticoids, phenytoin sodium, adrenocortical hormones.
Can cause blood sugar to rise, so it is necessary to increase the dosage of this product and closely monitor blood sugar at the same time. Pay close attention to the occurrence of hypoglycemia after stopping these drugs.
Beta receptor blocker
Non-selective beta blockers can increase the hypoglycemic effect of this product, which may mask the symptoms of hypoglycemia.
Ketoconazole, fluconazole, erythromycin
Can increase the blood concentration of this product, and should be avoided.
rifampin
Reduce the blood concentration of this product, so as to reduce the efficacy.
Third, biguanides
Application principles and precautions:
(1) Most guidelines recommend metformin as the first-line drug for patients with type 2 diabetes, especially those with obesity, overweight and hyperinsulinemia.
(2) It can be combined with other oral hypoglycemic drugs or insulin to further control blood sugar.
(3) In order to prevent and delay the development of impaired glucose tolerance into diabetes, metformin can be used if lifestyle intervention is ineffective.
(4) The main adverse effect is gastrointestinal reaction, which can be alleviated by starting with a small dose and gradually increasing the dose.
(5) It is forbidden for patients with abnormal liver and kidney function, patients in hypoxic state such as heart failure and chronic obstructive pulmonary disease, patients with past history of lactic acidosis, patients with acute and chronic metabolic acidosis, patients with recent upper gastrointestinal bleeding, patients with blood system diseases, and those who use contrast media on the same day.
(6) Interaction between metformin and other drugs:
Interacting drugs
Action result
Sulfonylurea hypoglycemic agents, insulin
It has synergistic hypoglycemic effect and increases the incidence of hypoglycemia, and the dosage should be reduced when combined.
Triamcinolone, amiloride, digoxin, quinidine, ranitidine, vancomycin, procainamide.
Theoretically, it can compete with this product for renal tubular transport system to enhance its efficacy. It is suggested to closely monitor and adjust the dosage.
Estrogen, calcium antagonists, thyroid preparations, contraceptives, sympathomimetic drugs, thiazide diuretics, glucocorticoids, phenothiazines.
Can cause blood sugar to rise, so the dosage of this product should be increased and blood sugar should be monitored. Pay close attention to the occurrence of hypoglycemia after stopping these drugs.
Vitamin B 12
This product can reduce the absorption of vitamin B 12 in intestine, reduce hemoglobin and produce megaloblastic anemia. Combined use can cause serious adverse reactions and should be avoided.
Indapamide
The combination is prone to lactic acidosis and should be avoided.
Dicoumarins
Combination can enhance anticoagulant effect and increase bleeding tendency, so it should be avoided.
Tetra, α-glucosidase inhibitor
Application principles and precautions:
(1) This product should be swallowed whole before meals or chewed with food just after eating.
(2) Start with small dosage and gradually increase the dosage as appropriate to reduce adverse reactions. The medicine is suitable for patients with carbohydrate as the main food component and high blood sugar after meals.
(3) The common adverse reactions are gastrointestinal reactions, such as abdominal distension and excessive exhaust. If it is serious, the dosage can be reduced first, and then gradually increased after the symptoms are relieved. If hypoglycemia occurs during medication, it should be corrected by intravenous infusion or oral glucose. Liver function should be monitored regularly during medication (especially when taking large doses).
(4) Pregnant women and lactating women,1teenagers under 8 years old are prohibited. Diabetic patients should use insulin instead of this product in special periods such as infection, trauma and surgery.
(5) Interaction between acarbose and other drugs:
Interacting drugs
Action result
Insulin and other oral hypoglycemic agents
Combined use will enhance the hypoglycemic effect and increase the risk of hypoglycemia, so we should use drugs carefully from a small dose.
Thyroid hormone, adrenaline and coleenamine digestive enzyme preparation
Reduce the hypoglycemic effect of this product and reduce the drug effect.
V thiazolidinedione
Application principles and precautions:
(1) Use with caution in patients with cardiac insufficiency, hypertension and edema, and closely monitor the symptoms and signs of those at risk of heart failure.
(2) Pay attention to liver function during the application of this kind of drugs, especially for elderly patients and those with impaired liver function. Patients with active liver disease or transaminase increase more than 2.5 times the normal upper limit are prohibited.
(3) Elderly patients may have mild to moderate edema, mild anemia and weight gain.
(4) Do not break the tablet when taking it.
(5) It does not cause hypoglycemia when used alone, but it can increase the risk of hypoglycemia when used in combination with insulin or insulin secretagogue.
(6) Pregnant and lactating women, children and teenagers under 18 years old are prohibited.
(7) Interaction between thiazolidinediones and other antidiabetic drugs:
Interacting drugs
Action result
Sulfonylureas
Combined use has synergistic hypoglycemic effect, enhances hypoglycemic effect and increases the risk of hypoglycemia.
melbine
Combination has synergistic hypoglycemic effect and does not increase the side effects of metformin, so it is recommended to use combination.
acarbose
Do not affect each other, and the dosage does not need to be adjusted when combined.
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The article comes from Li Muzi, author of Medical Endocrinology Channel.