EryPed and Repaglinide and Metformin Tablets

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Erythromycin may increase the blood levels of repaglinide. You may be more likely to experience side effects such as hypoglycemia, or low blood sugar, that can sometimes occur with the use of repaglinide. Symptoms of hypoglycemia include headache, dizziness, drowsiness, nervousness, weakness, tremor, nausea, hunger, sweating, and palpitation. The risk of other serious but uncommon side effects such as fluid retention, macular edema (swelling in the back of the eye), new or worsening heart failure, bone fractures, anemia, and liver problems may also be increased. You may need a dose adjustment or more frequent monitoring of your blood sugar and other tests to safely use both medications. Contact your doctor immediately if you experience blurred vision or other visual abnormalities; excessive or rapid weight gain; swelling in the ankles or legs; shortness of breath or difficulty breathing; unusual tiredness; chest pain or tightness; or worsening of existing heart problems. You should also seek prompt medical attention if you develop signs and symptoms of liver damage such as fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, light colored stools, and yellowing of the skin or eyes. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

MONITOR: Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of repaglinide, which is partially metabolized by the isoenzyme. In nine healthy volunteers, administration of a single 0.25 mg dose of repaglinide following pretreatment with the potent CYP450 3A4 inhibitor clarithromycin (250 mg orally twice a day for 4 days) resulted in a 66% increase in mean repaglinide peak plasma concentration (Cmax) and a 41% increase in systemic exposure (AUC) compared to administration after placebo. Clarithromycin also increased the mean elimination half-life of repaglinide from 1.4 to 1.7 hours, as well as the mean incremental AUC (0 to 3 hours) of serum insulin by 51% and the maximum increase in serum insulin by 61%. Similarly, in 12 healthy volunteers, pretreatment with itraconazole (200 mg orally followed by 100 mg twice daily for 3 days) increased the AUC of a single 0.25 mg dose of repaglinide by 40% compared to administration after placebo. In eight healthy male volunteers, the mean Cmax and AUC of a single 2 mg dose of repaglinide increased by 7% and 15%, respectively, following pretreatment with ketoconazole 200 mg/day for 5 days. No significant differences in blood glucose levels or adverse events were observed in these studies between repaglinide alone and in combination with the CYP450 3A4 inhibitor. However, clinical significance of the interaction in diabetics cannot be precluded due to potentially reduced counter-regulatory response to hypoglycemia in these patients. CYP450 3A4 inhibitors can also enhance the pharmacokinetic interaction between repaglinide and CYP450 2C8 and/or OATP 1B1 inhibitors such as gemfibrozil. In 12 healthy volunteers, gemfibrozil (600 mg orally twice a day for 3 days) alone increased the AUC of a single 0.25 mg dose of repaglinide by 8.1-fold compared to placebo and prolonged its half-life from 1.3 to 3.7 hours, while gemfibrozil plus itraconazole (200 mg orally followed by 100 mg twice daily for 3 days) increased the AUC of repaglinide by 19.4-fold and prolonged its half-life to 6.1 hours. Plasma repaglinide concentration at 7 hours was increased 28.6-fold by gemfibrozil and 70.4-fold by gemfibrozil plus itraconazole. Rare cases of severe hypoglycemia have been reported in patients taking this combination during postmarketing surveillance.

MANAGEMENT: Because the antidiabetic effect of repaglinide is dose- and concentration-dependent, pharmacologic response to repaglinide should be monitored more closely whenever a CYP450 3A4 inhibitor is added to or withdrawn from therapy. Patients should be advised to regularly monitor their blood sugar and counseled on how to recognize and treat hypoglycemia, which may include symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, and palpitations. The repaglinide dosage may require adjustment if an interaction is suspected.

EryPed

Generic Name: erythromycin

Brand name: E. E. S, EryPed, EES. Granules, EES-400 Filmtab, EryPed 200, EryPed 400, Ery-Tab, Erythrocin Lactobionate, Erythrocin Stearate Filmtab, PCE Dispertab, Erythrocin, Erythromycin Filmtabs, Erythromycin Lactobionate - IV

Synonyms: n.a.

What is EryPed?

Repaglinide and Metformin Tablets

Generic Name: metformin / repaglinide

Brand name: PrandiMet

Synonyms: Metformin and repaglinide, Repaglinide and Metformin

What is Repaglinide and Metformin Tablets?