A client with diabetes mellitus visits a health care clinic. The client’s diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently, the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia?
A. prednisone (Deltasone)
B. atenolol (Tenormin)
C. phenelzine (Nardil)
D. allopurinol (Zyloprim)
Correct Answer: A. prednisone (Deltasone)
Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Prednisone may interfere with blood glucose control and reduce the effectiveness of metFORMIN and other diabetic medications. Monitor blood sugar levels closely. The client may need a dose adjustment of the diabetic medications during and after treatment with prednisone.
Option B: Research results indicated that atenolol can inhibit urinary excretion of metformin via decreasing renal rMate1 expression, and long-term atenolol and metformin co-administration may induce potential lactic acidosis.
Option C: Phenelzine may lower blood sugar levels. However, it does not have any effects when taken with oral hypoglycemic agents. Some products that may interact with this drug include: other antidepressants (including maprotiline, mirtazapine, nefazodone, TCAs such as amitriptyline/nortriptyline), appetite suppressants (such as diethylpropion), drugs for attention deficit disorder (such as atomoxetine, methylphenidate), apraclonidine, bupropion, etc.
Option D: No interactions were found between allopurinol and metformin. Allopurinol may also increase the risk of developing a rash if taken with antibiotics ampicillin or amoxicillin. Allopurinol may also increase the effect of warfarin and other drugs that thin the blood. These are known as anticoagulants.
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