Wechselwirkungen von Canagliflozin

Hypoglycemia Chloroquine has been shown to cause severe hypoglycemia including loss of consciousness that could be life-threatening in patients treated with or without antidiabetic medications (see PRECAUTIONS , Drug Interactions ). (Fachinformation zu Chloroquin, Warnhinweise)

Antidiabetic agents Hypoglycemia including fatal outcomes have been reported. (Fachinformation zu Ciprofloxacin, Arzneimittelwechselwirkungen)

Oral hypoglycemics Clinically significant hypoglycemia may be precipitated by the use of fluconazole with oral hypoglycemic agents; one fatality has been reported from hypoglycemia in association with combined fluconazole and glyburide use. (Fachinformation zu Fluconazol, Arzneimittelwechselwirkungen)

This warning is based on the study conducted by the University Group Diabetes Program (UGDP), a long-term prospective clinical trial designed to evaluate the effectiveness of glucose-lowering drugs in preventing or delaying vascular complications in patients with non-insulin-dependent diabetes. (Fachinformation zu Glipizid und Metformin, Gegenanzeigen)

Hypoglycemia PLAQUENIL can cause severe and potentially life-threatening hypoglycemia, in the presence or absence of antidiabetic agents [see Drug Interactions (7) ]. (Fachinformation zu Hydroxychloroquin, Warnhinweise und Vorsichtsmaßnahmen)

Monitor blood glucose in patients with diabetes and assess if antidiabetic agent dose modifications are required. (Fachinformation zu Abirateron, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Oral Hypoglycemics Moderate doses of aspirin may increase the effectiveness of oral hypoglycemic drugs, leading to hypoglycemia. (Fachinformation zu Acetylsalicylsäure und Dipyridamol, Arzneimittelwechselwirkungen)

Glyburide: In a trial of 7 healthy male volunteers, acitretin treatment potentiated the blood glucose-lowering effect of glyburide (a sulfonylurea similar to chlorpropamide) in 3 of the 7 subjects. (Fachinformation zu Acitretin, Arzneimittelwechselwirkungen)

Precipitating conditions for diabetic ketoacidosis or other ketoacidosis include under-insulinization due to insulin dose reduction or missed insulin doses, acute febrile illness, reduced caloric intake, ketogenic diet, surgery, volume depletion, and alcohol abuse. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Antidiabetic Agents: In rare cases, diabetic patients receiving an ACE inhibitor (including benazepril) concomitantly with insulin or oral antidiabetics may develop hypoglycemia. (Fachinformation zu Amlodipin und Benazepril, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Some patients required either initiation or dose adjustments of insulin or oral hypoglycemic agents for treatment of these events. (Fachinformation zu Atazanavir, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Antidiabetics: Increased risk of hypoglycemia ( 7.2 ) (Fachinformation zu Benazepril, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

However, patients subject to spontaneous hypoglycemia, or diabetic patients receiving insulin or oral hypoglycemic agents, should be cautioned about these possibilities and bisoprolol fumarate should be used with caution. (Fachinformation zu Bisoprolol, Warnhinweise)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Masking of Hypoglycemic Symptoms in Patients with Diabetes Mellitus Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. (Fachinformation zu Brimonidin und Timolol, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Oral antidiabetic agents and insulin, causing hypoglycemia by contributing an additive effect, if dosage of Butalbital, Aspirin, and Caffeine Capsules exceeds maximum recommended daily dosage. (Fachinformation zu Butalbital, Acetylsalicylsäure und Koffein, Arzneimittelwechselwirkungen)

Evaluate the blood pressure and renal function of patients Examples: Metoprolol, propranolol Hypoglycemic Agents Clinical Impact: Aspirin may increase the serum glucose-lowering action of insulin and sulfonylureas leading to hypoglycemia. (Fachinformation zu Butalbital, Acetylsalicylsäure, Koffein und Codein, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Closely monitor for adverse reactions of CYP2C9 substrates where minimal concentration changes may lead to serious adverse reactions when used concomitantly with XELODA (e.g., anticoagulants, antidiabetic drugs). (Fachinformation zu Capecitabin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Insulin and oral hypoglycemics action may be enhanced. (Fachinformation zu Carvedilol, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Oral Hypoglycemic Agents/Insulin: The concomitant use of clarithromycin tablets and oral hypoglycemic agents and/or insulin can result in significant hypoglycemia. (Fachinformation zu Clarithromycin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Caution should be exercised when used with antidiabetic drugs. (Fachinformation zu Danazol, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Initiation or dose adjustments of insulin or oral hypoglycemic agents may be required. (Fachinformation zu Darunavir, Warnhinweise und Vorsichtsmaßnahmen)

Some patients required either initiation or dose adjustments of insulin or oral hypoglycemic agents for treatment of these events. (Fachinformation zu Darunavir und Cobicistat, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Digoxin Clinical Impact: Canagliflozin increases digoxin exposure [see Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Masking of Hypoglycemic Symptoms in Patients with Diabetes Mellitus Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. (Fachinformation zu Dorzolamid und Timolol, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Monitor for symptoms of hyperglycemia; adjust dosage of antidiabetic drug upward if necessary. (Fachinformation zu Fludrocortison, Arzneimittelwechselwirkungen)

As is true with many other types of medication when taken concurrently by patients with diabetes, insulin and/or oral hypoglycemic, dosage may need to be adjusted when therapy with PROZAC is instituted or discontinued. (Fachinformation zu Fluoxetin, Warnhinweise und Vorsichtsmaßnahmen)

Some patients required either initiation or dose adjustments of insulin or oral hypoglycemic agents for treatment of these events. (Fachinformation zu Fosamprenavir, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Antidiabetic Agents Clinical Impact: Corticosteroids in supraphysiologic doses may increase blood glucose concentrations. (Fachinformation zu Hydrocortison, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Antidiabetic Drugs Repaglinide Saxagliptin Monitor for adverse reactions. (Fachinformation zu Itraconazol, Arzneimittelwechselwirkungen)

Antidiabetics repaglinide, saxagliptin Antihelmintics and Antiprotozoals praziquantel Antimigraine Drugs ergot alkaloids, such as dihydroergotamine, ergometrine (ergonovine), ergotamine, methylergometrine (methylergonovine) eletriptan Ergot alkaloids: The potential increase in plasma concentrations of ergot alkaloids when coadministered with ketoconazole tablets… (Fachinformation zu Ketoconazol, Arzneimittelwechselwirkungen)

Hyperglycemia and Hypoglycemia : Glucose monitoring is recommended and antidiabetic treatment adjusted accordingly. (Fachinformation zu Lanreotid, Warnhinweise und Vorsichtsmaßnahmen)

Blood Glucose Disturbances Fluoroquinolones, including Levofloxacin in 5% Dextrose Injection, have been associated with disturbances of blood glucose, including symptomatic hyperglycemia and hypoglycemia, usually in diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g., glyburide) or with insulin. (Fachinformation zu Levofloxacin, Warnhinweise und Vorsichtsmaßnahmen)

Worsening of Diabetic Control : May worsen glycemic control and result in increased antidiabetic agent or insulin requirements. (Fachinformation zu Levothyroxin, Warnhinweise und Vorsichtsmaßnahmen)

Insulin or Oral Hypoglycemics — Initiating thyroid replacement therapy may cause increases in insulin or oral hypoglycemic requirements. (Fachinformation zu Levothyroxin und Liothyronin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

• Hypoglycemia: Postmarketing cases of symptomatic hypoglycemia have been reported in patients with diabetes mellitus receiving insulin or oral hypoglycemic agents. (Fachinformation zu Linezolid, Warnhinweise und Vorsichtsmaßnahmen)

• Worsening of diabetic control: Therapy in patients with diabetes mellitus may worsen glycemic control and result in increased antidiabetic agent or insulin requirements. (Fachinformation zu Liothyronin, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Antidiabetics Concomitant administration of Zestril and antidiabetic medicines (insulins, oral hypoglycemic agents) may cause an increased blood-glucose-lowering effect with risk of hypoglycemia. (Fachinformation zu Lisinopril, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Lithium Clinical Impact: Concomitant use of an SGLT2 inhibitor with lithium may decrease serum lithium concentrations. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Antidiabetics : Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. (Fachinformation zu Methylprednisolon, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Antidiabetic agents Carefully monitor blood glucose. (Fachinformation zu Moxifloxacin, Arzneimittelwechselwirkungen)

Beta-blockade also reduces the release of insulin in response to hyperglycemia; therefore, it may be necessary to adjust the dose of antidiabetic drugs. (Fachinformation zu Nadolol, Warnhinweise)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Use of Antidiabetic Medications: Weight loss may cause hypoglycemia. (Fachinformation zu Naltrexon und Bupropion, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Hypoglycemia or Hyperglycemia: Monitor glucose and adjust antidiabetic treatment as needed (‎ 5.2 ). (Fachinformation zu Octreotid, Warnhinweise und Vorsichtsmaßnahmen)

Fluoroquinolones have been associated with disturbances of blood glucose, including symptomatic hyperglycemia and hypoglycemia, usually in diabetic patients receiving concomitant treatment with an oral hypoglycemic agent (e.g., glyburide) or with insulin. (Fachinformation zu Ofloxacin, Warnhinweise)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

A reduction in dose of oral hypoglycemic medication (e.g., sulfonylureas) or insulin may be required in some patients [see Clinical Studies (14) ] . (Fachinformation zu Orlistat, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

• A reduction in dose of insulin or oral hypoglycemic medication may be required in some patients. (Fachinformation zu Phentermin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Beta-blockade also reduces the release of insulin in response to hyperglycemia; therefore, it may be necessary to adjust the dose of antidiabetic drugs. (Fachinformation zu Pindolol, Warnhinweise)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Antidiabetic Agents: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. (Fachinformation zu Prednisolon, Arzneimittelwechselwirkungen)

Antidiabetic agents: May increase blood glucose concentrations. (Fachinformation zu Prednison, Arzneimittelwechselwirkungen)

Monitor patients for the development of edema when co-administering LYRICA CR and thiazolidinedione antidiabetic agents. (Fachinformation zu Pregabalin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Examples: Rifampin, phenytoin, phenobarbital, ritonavir Insulin or Insulin Secretagogues Clinical Impact: The risk of hypoglycemia is increased when INVOKANA is used concomitantly with insulin secretagogues (e.g., sulfonylurea) or insulin. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Salicylates may enhance the hypoglycemic effect of oral antidiabetic drugs of the sulfonylurea class. (Fachinformation zu Salsalat, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Consider adding another antihyperglycemic agent in patients who require additional glycemic control [see Dosage and Administration (2.3) and Clinical Pharmacology (12.3) ] . (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

The doses of antidiabetic agents may require adjustment when HUMATROPE is initiated. (Fachinformation zu Somatropin, Warnhinweise und Vorsichtsmaßnahmen)

Insulin and Oral Antidiabetics Hyperglycemia may occur, and the dosage of insulin or antidiabetic drugs may require adjustment. (Fachinformation zu Sotalol, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Like other sulfonamide-containing drugs, sulfamethoxazole and trimethoprim potentiates the effect of oral hypoglycemics. (Fachinformation zu Sulfamethoxazol und Trimethoprim (Cotrimoxazol), Arzneimittelwechselwirkungen)

• Hypoglycemia : Check blood glucose levels regularly and assess if antidiabetic drug dose modifications are required. (Fachinformation zu Sunitinib, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

This may result in the need for an increase in the dose of, or initiation of, insulin and/or oral hypoglycemic agent therapy. (Fachinformation zu Temsirolimus, Warnhinweise und Vorsichtsmaßnahmen)

Masking of Hypoglycemic Symptoms in Patients with Diabetes Mellitus Beta-adrenergic blocking agents should be administered with caution in patients subject to spontaneous hypoglycemia or to diabetic patients (especially those with labile diabetes) who are receiving insulin or oral hypoglycemic agents. (Fachinformation zu Timolol, Warnhinweise und Vorsichtsmaßnahmen)

• Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues : Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with INVOKANA ( 5.5 ). (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (Fachinformation zu Canagliflozin, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

(See PRECAUTIONS . ) Antidiabetic Agents Concomitant use of ACE inhibitors and antidiabetic medicines (insulin or oral hypoglycemic agents) may cause an increased blood glucose lowering effect with greater risk of hypoglycemia. (Fachinformation zu Trandolapril, Arzneimittelwechselwirkungen)

Hypoglycemia in Diabetic Patients Some MAOIs have contributed to hypoglycemic episodes in diabetic patients receiving insulin or other blood-glucose-lowering agents. (Fachinformation zu Tranylcypromin, Warnhinweise und Vorsichtsmaßnahmen)

Antidiabetics: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. (Fachinformation zu Triamcinolon, Arzneimittelwechselwirkungen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Patients with impaired renal function (eGFR less than 60 mL/min/1.73 m 2 ), elderly patients, or patients on loop diuretics may be at increased risk for volume depletion or hypotension. (Fachinformation zu Canagliflozin, Warnhinweise und Vorsichtsmaßnahmen)

Sulfonylurea Oral Hypoglycemics (CYP2C9 Inhibition) Not Studied In Vivo or In Vitro , but Drug Plasma Exposure Likely to be Increased Frequent monitoring of blood glucose and for signs and symptoms of hypoglycemia. (Fachinformation zu Voriconazol, Arzneimittelwechselwirkungen)

Antidiabetic drug requirements (i.e., insulin) may be altered. (Fachinformation zu Amfepramon, Arzneimittelwechselwirkungen)

Additional predisposing conditions include diabetes mellitus treated with oral hypoglycemic drugs or insulin, use of anorectic drugs, excessive use of alcohol, use of benzodiazepines, sedatives/hypnotics, or opiates. (Fachinformation zu Bupropion, Warnhinweise und Vorsichtsmaßnahmen)

In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of antidiabetic treatment despite discontinuation of the suspect drug. (Fachinformation zu Clozapin, Warnhinweise und Vorsichtsmaßnahmen)

Oral Hypoglycemic Agents In pharmacokinetic studies of lovastatin in hypercholesterolemic non-insulin dependent diabetic patients, there was no drug interaction with glipizide or with chlorpropamide (see CLINICAL PHARMACOLOGY , Clinical Studies in Adults ). (Fachinformation zu Lovastatin, Arzneimittelwechselwirkungen)

Although the systemic absorption of miconazole following ORAVIG administration is minimal and plasma concentrations of miconazole are substantially lower than when given intravenously, the potential for interaction with drugs metabolized through CYP2C9 and CYP3A4 such as oral hypoglycemics, phenytoin, or ergot alkaloids cannot be ruled out. (Fachinformation zu Miconazol, Arzneimittelwechselwirkungen)

Moexipril hydrochloride has been used in clinical trials concomitantly with calcium-channel-blocking agents, diuretics, H 2 blockers, digoxin, oral hypoglycemic agents, and cholesterol-lowering agents. (Fachinformation zu Moexipril, Arzneimittelwechselwirkungen)

Glucose Lowering Drugs Pioglitazone: Co-administration of pioglitazone for 7 days with 30 mg nifedipine ER administered orally q.d. for 4 days to male and female volunteers resulted in least square mean (90% CI) values for unchanged nifedipine of 0.83 (0.73-0.95) for C max and 0.88 (0.80-0.96) for AUC relative to nifedipine monotherapy. (Fachinformation zu Nifedipin, Vorsichtsmaßnahmen)

Insulin and Oral Hypoglycemic Medications Requirements may be altered. (Fachinformation zu Phendimetrazin, Arzneimittelwechselwirkungen)

Potentiation of the action of sulfonylurea hypoglycemic agents, thiazide diuretics and uricosuric agents may also be noted. (Fachinformation zu Sulfadiazin, Arzneimittelwechselwirkungen)

Drug Interactions with Amlodipine In clinical trials, amlodipine has been safely administered with thiazide diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, long-acting nitrates, sublingual nitroglycerin, digoxin, warfarin, non-steroidal anti-inflammatory drugs, antibiotics, and oral hypoglycemic drugs. (Fachinformation zu Telmisartan und Amlodipin, Arzneimittelwechselwirkungen)

Hypoglycemic Agents: In adult diabetic patients under treatment with either sulfonylureas or insulin there is no change in the clinical effects of either TOLECTIN or the hypoglycemic agents. (Fachinformation zu Tolmetin, Arzneimittelwechselwirkungen)

In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of antidiabetic treatment despite discontinuation of the suspect drug. (Fachinformation zu Ziprasidon, Warnhinweise und Vorsichtsmaßnahmen)

Oral hypoglycemic agents Although sulindac and its sulfide metabolite are highly bound to protein, studies in which sulindac was given at a dose of 400 mg daily, have shown no clinically significant interaction with oral hypoglycemic agents. (Fachinformation zu Sulindac, Arzneimittelwechselwirkungen)