Nizoral and Tol-Tab

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.

Ketoconazole may increase the blood levels and effects of TOLBUTamide. This can increase the risk of hypoglycemia (low blood sugar). Symptoms include headache, dizziness, drowsiness, nervousness, weakness, tremor, nausea, hunger, sweating, and fast or pounding heartbeats. You may need a dose adjustment or more frequent monitoring of your blood sugar to safely use both medications. 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 ketoconazole may increase the plasma concentrations of tolbutamide. The exact mechanism of interaction is unknown. Ketoconazole has been shown to inhibit the hydroxylation of tolbutamide in vitro. However, ketoconazole is not known to significantly inhibit CYP450 2C9 or 2C19, the isoenzymes primarily responsible for the metabolic clearance of tolbutamide. In seven healthy volunteers, administration of a single 500 mg dose of tolbutamide following ketoconazole 200 mg/daily for 7 days resulted in a 77% increase in tolbutamide systemic exposure (AUC) and a prolongation of its elimination half-life from 3.7 hours to 12.3 hours. Blood glucose reduction was greater when tolbutamide was administered with ketoconazole than when administered alone. Five subjects also experienced mild symptoms of hypoglycemia (weakness, sweating and reeling sensation) during treatment with the combination. Clinical effects of the interaction may be increased in diabetics due to potentially reduced counter-regulatory response to hypoglycemia in these patients.

MANAGEMENT: Caution is advised if tolbutamide is used in combination with ketoconazole. Blood glucose should be closely monitored, and the tolbutamide dosage adjusted as necessary. Patients should also be apprised of the increased risk of hypoglycemia and be alert to potential signs and symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, and palpitations.

Nizoral

Generic Name: ketoconazole

Brand name: Nizoral

Synonyms: n.a.

What is Nizoral?

Tol-Tab

Generic Name: tolbutamide

Brand name: Orinase, Orinase Diagnostic, Tol-Tab

Synonyms: Tol-Tab (Oral)

What is Tol-Tab?