Forbetes Plus 500/5 Drug Interactions

Contraindicated Combination: Related to Glibenclamide: Miconazole: Increase in the hypoglycaemic effect with possible onset of hypoglycaemic manifestations (see Contraindications).
Combination Not Recommended: Related to Sulfonylurea(s): Alcohol: Increase of the hypoglycaemic reaction (inhibition of compensation reactions), which may facilitate the onset of a hypoglycaemic coma manifestations (see Contraindications). Avoid consumption of alcohol and alcohol-containing medications.
Related to All Antidiabetic Agents: Danazol: If the combination cannot avoided, warn the patient and step up self-monitoring of blood glucose. Possibly adjust the dosage of the antidiabetic treatment during treatment with Danazol and after its withdrawal.
Related to Metformin: Alcohol: Alcohol intoxication is associated with an increased risk of lactic acidosis, particularly in cases of fasting, malnutrition or hepatic impairment.
Iodinated contrast agents: This product must be discontinued prior to or at the time of the imaging procedure and not restarted until at least 48 hours after, provided that renal function has been reevaluated and found to be stable, see Precautions.
Combinations Requiring Precautions: Related to All Antidiabetic Agents: Chlorpromazine At high dosages (100 mg per day of Chlorpromazine), elevation in blood glucose (reduction in release of Insulin).
Precaution for use: warn the patient and step up self monitoring of blood glucose. Possibly adjust the dosage of the antidiabetic treatment with the neuroleptic and after its withdrawal.
Corticosteroids (glucocorticoids and tetracosactides (systemic and local routes): Elevation in blood glucose, sometimes accompanied by ketosis (decreased carbohydrate tolerance with corticosteroids).
Precaution for use: warn the patient and step up self monitoring of blood glucose. Possibly adjust the dosage of the antidiabetic treatment with the neuroleptic and after its withdrawal.
Beta-agonists: Elevation in blood glucose due to the beta-agonists.
Precaution for use: warn the patient, step up blood glucose monitoring and possibly transfer to Insulin therapy.
Drugs reducing glycemic control: Certain drugs tend to produce hyperglycemia and may lead to loss of blood glucose control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. When such drugs are administrated to a patient receiving this product, the patient should be closely observed for loss of blood glucose control. When such drugs are withdrawn from a patient receiving this product, the patient should be observed closely for hypoglycemia.
Drugs that potentiate the hypoglycemic action of this product The hypoglycemic action of sulfonylureas may be potentiated by certain drugs including nonsteroidal anti-inflammatory agents and other drugs that are highly protein bound, salicylates, sulfonamides, Chloramphenicol, Probenecid, Coumarins, monoamine oxidase inhibitors, beta-adrenergic blocking agents, and potentially with Ciprofloxacin. When such drugs are administered to a patient receiving this product, the patient should be observed closely for hypoglycemia. When such drugs are withdrawn from a patient receiving this product, the patient should be observed closely for loss of blood glucose control.
Related to Metformin: Some medicinal products can adversely affect renal function which may increase the risk of lactic acidosis, e.g. NSAIDs, including selective cyclooxygenase (COX) II inhibitors, ACE inhibitors, angiotensin II receptor antagonists and diuretics, especially loop diuretics. When starting of using such products in combination with Metformin, close monitoring of renal function is necessary.
Organic cation transporters (OCT): Metformin is a substrate of both transporters OCT1 and OCT2.
Co-administration of Metformin with: Inhibitors of OCT1 (such as Verapamil) may reduce efficacy of Metformin.
Inducers of OCT1 (such as Rifampicin) may increase gastrointestinal absorption and efficacy.
Inhibitors of OCT2 (such as Cimetidine, Dolutegravir, Ranolazine, Trimethoprim, Daclatasvir, Vandetanib, Isavuconazole) may decrease the renal elimination of Metformin and thus lead to an increase Metformin plasma concentration.
Inhibitors of both OCT1 and OCT2 (such as Crizotinib, Olaparib) may alter efficacy and renal elimination of Metformin.
Caution is therefore advised, especially in patients with renal impairment, when these drugs are coadministered with Metformin, as Metformin plasma concentration may increase. If needed, dose adjustment of Metformin may be considered as OCT inhibitors/ inducers may alter the efficacy of Metformin.
Related to Glibenclamide: Beta-blockers: All beta-blockers mask some of the symptoms of hypoglycaemia: palpitations and tachycardia. Most non-cardioselective beta-blockers increase the incidence and severity of hypoglycaemia. Warn the patient and step up blood glucose self-monitoring, especially at the start of treatment.
Angiotensin converting enzyme inhibitors (e.g., Captopril, Enalapril): ACE inhibitors may decrease the blood glucose levels. If necessary, adjust the dosage of this product during therapy with an ACE inhibitor and upon its discontinuation.
Fluconazole: Increase in the half-life of Sulphonylurea with possible onset of hypoglycaemic manifestations. Warn the patient and step up blood glucose self monitoring, and possibly adjust the dosage of the antidiabetic treatment during treatment with Fluconazole and after its withdrawal.
Bosentan: Risk of decreased hypoglycaemic effect of Glibenclamide because Bosentan reduces plasma concentration of Glibenclamide. An increase risk of liver enzyme elevations was reported in patients receiving Glibenclamide concomitantly with Bosentan. Warn the patient, set-up monitoring of glycaemia and liver enzymes and adjust the dosage of the antidiabetic treatment if necessary.
Bile acid sequestrants: When co-administered simultaneously the plasma concentration of Glibenclamide is reduced which may lead to a reduced hypoglycaemic effect. This effect was not observed if Glibenclamide is given in a certain period of time before taking the other medicine. It is recommended that this product should be administered at least 4 hours prior a bile acid sequestrant.