Tirzepatide interactions

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 ). (Chloroquine label, Warnings)

Antidiabetic agents Hypoglycemia including fatal outcomes have been reported. (Ciprofloxacin label, Drug interactions)

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. (Fluconazole label, Drug interactions)

These conditions should be treated with insulin. (Glyburide label, Contraindications)

Hypoglycemia PLAQUENIL can cause severe and potentially life-threatening hypoglycemia, in the presence or absence of antidiabetic agents [see Drug Interactions (7) ]. (Hydroxychloroquine label, Warnings and precautions)

To avoid medication errors between LEVEMIR and other insulins, instruct patients to always check the insulin label before each injection. (Insulin detemir label, Warnings and precautions)

To avoid medication errors between LYUMJEV and other insulins, instruct patients to always check the insulin label before each injection. (Insulin lispro label, Warnings and precautions)

WARNING: RISK OF THYROID C-CELL TUMORS In rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. (Tirzepatide label, Boxed warning)

WARNING: RISK OF THYROID C-CELL TUMORS In rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. (Tirzepatide label, Boxed warning)

WARNING: RISK OF THYROID C-CELL TUMORS In rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. (Tirzepatide label, Boxed warning)

WARNING: RISK OF THYROID C-CELL TUMORS In rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. (Tirzepatide label, Boxed warning)

When such drugs are withdrawn from patients receiving acarbose tablets in combination with sulfonylureas or insulin, patients should be observed closely for any evidence of hypoglycemia. (Acarbose label, Drug interactions)

Consideration should be taken in patients being treated with antidiabetic agents. (Acetazolamide label, Drug interactions)

Alcohol can cause low blood sugar with insulin or sulfonylureas, and heavy drinking with metformin raises the risk of lactic acidosis. (NIAAA, Harmful Interactions: Mixing Alcohol with Medicines)

Antidiabetic Agents: In rare cases, diabetic patients receiving an ACE inhibitor (including benazepril) concomitantly with insulin or oral antidiabetics may develop hypoglycemia. (Amlodipine and benazepril label, Drug interactions)

Oral Hypoglycemics Moderate doses of aspirin may increase the effectiveness of oral hypoglycemic drugs, leading to hypoglycemia. (Aspirin and dipyridamole label, Drug interactions)

Antidiabetics: Increased risk of hypoglycemia ( 7.2 ) (Benazepril label, Drug interactions)

Nonselective beta-blockers may potentiate insulin-induced hypoglycemia and delay recovery of serum glucose levels. (Bisoprolol label, Warnings)

Also, latent diabetes mellitus may become manifest and diabetic patients given thiazides may require adjustment of their insulin dose. (Bisoprolol and hydrochlorothiazide label, Warnings)

• 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 ). (Canagliflozin label, Warnings and precautions)

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). (Capecitabine label, Drug interactions)

During the 8-week trial, serum insulin levels increased by 12 pmol/L in the VRAYLAR 1 mg to 2 mg per day group, 20 pmol/L in the VRAYLAR 2 mg to 4.5 mg per day group, and 8.5 pmol/L in the placebo group. (Cariprazine label, Warnings and precautions)

Insulin and oral hypoglycemics action may be enhanced. (Carvedilol label, Drug interactions)

Oral Hypoglycemic Agents/Insulin: The concomitant use of clarithromycin tablets and oral hypoglycemic agents and/or insulin can result in significant hypoglycemia. (Clarithromycin label, Warnings and precautions)

…placebo) and when colesevelam hydrochloride was used in combination with pioglitazone (median increase 11% compared to placebo in combination with pioglitazone), sulfonylureas (median increase 18% compared to placebo in combination with sulfonylureas), and insulin (median increase 22% compared to placebo in combination with insulin) [see Adverse Reactions (6.1) ]. (Colesevelam label, Warnings and precautions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

• Hypoglycemia: Consider a lower dose of insulin or the insulin secretagogue to reduce the risk of hypoglycemia when used in combination with DAPAGLIFLOZIN TABLETS. (Dapagliflozin label, Warnings and precautions)

Hyperglycemia Corticosteroids can increase blood glucose, worsen pre-existing diabetes, and predispose those on long-term therapy to diabetes mellitus, and may reduce the effect of the antidiabetic drugs. (Dexamethasone label, Warnings and precautions)

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. (Dorzolamide and timolol label, Warnings and precautions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Hypoglycemia: Concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia, including severe hypoglycemia. (Dulaglutide label, Warnings and precautions)

Hypoglycemia: Adult patients taking an insulin secretagogue or insulin may have an increased risk of hypoglycemia. (Empagliflozin label, Warnings and precautions)

Hypoglycemia: Adult patients taking an insulin secretagogue or insulin may have an increased risk of hypoglycemia. (Empagliflozin and metformin label, Warnings and precautions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

• Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin: Patients taking an insulin secretagogue or insulin may have an increased risk of hypoglycemia, including severe hypoglycemia. (Exenatide label, Warnings and precautions)

Monitor for symptoms of hyperglycemia; adjust dosage of antidiabetic drug upward if necessary. (Fludrocortisone label, Drug interactions)

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. (Fluoxetine label, Warnings and precautions)

Hypoglycemia: Concomitant use with insulin or an insulin secretagogue may increase the risk of hypoglycemia, including severe hypoglycemia. (Tirzepatide label, Warnings and precautions)

Hypoglycemia: Concomitant use with insulin or an insulin secretagogue may increase the risk of hypoglycemia, including severe hypoglycemia. (Tirzepatide label, Warnings and precautions)

Hypoglycemia in Patients with Insulinoma: In patients with insulinoma, administration may produce an initial increase in blood glucose; however, glucagon may stimulate exaggerated insulin release from an insulinoma and cause hypoglycemia. (Glucagon label, Warnings and precautions)

Hypoglycemia: Concomitant use with insulin or an insulin secretagogue may increase the risk of hypoglycemia, including severe hypoglycemia. (Tirzepatide label, Warnings and precautions)

Antidiabetic drugs: Dosage adjustment of antidiabetic may be required (7.2) (Hydrochlorothiazide label, Drug interactions)

Antidiabetic Agents Clinical Impact: Corticosteroids in supraphysiologic doses may increase blood glucose concentrations. (Hydrocortisone label, Drug interactions)

Hydroxyurea may falsely elevate sensor glucose results from certain continuous glucose monitoring (CGM) systems and may lead to hypoglycemia if sensor glucose results are relied upon to dose insulin. (Hydroxyurea label, Warnings and precautions)

Increase frequency of glucose monitoring with changes to: insulin dosage, concomitantly administered glucose lowering medications, meal pattern, physical activity; and in patients with renal or hepatic impairments and hypoglycemia unawareness ( 5. (Insulin aspart label, Warnings and precautions)

The risk of hypoglycemia after an injection is related to the duration of action of the insulin [see Clinical Pharmacology ( 12.2 )] and, in general, is highest when the glucose lowering effect of the insulin is maximal. (Insulin degludec label, Warnings and precautions)

For patients with type 2 diabetes, dosage adjustments of concomitant oral and antidiabetic products may be needed. (Insulin glargine label, Warnings and precautions)

For patients with type 2 diabetes mellitus, oral antidiabetic treatment dosage modifications may be needed. (Insulin regular (human) label, Warnings and precautions)

Antidiabetic Drugs Repaglinide Saxagliptin Monitor for adverse reactions. (Itraconazole label, Drug interactions)

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… (Ketoconazole label, Drug interactions)

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. (Levofloxacin label, Warnings and precautions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Hypoglycemia: Consider lowering the dosage of insulin secretagogue or insulin to reduce the risk of hypoglycemia when initiating TRADJENTA ( 5.2 ) (Linagliptin label, Warnings and precautions)

• Hypoglycemia: Postmarketing cases of symptomatic hypoglycemia have been reported in patients with diabetes mellitus receiving insulin or oral hypoglycemic agents. (Linezolid label, Warnings and precautions)

• Hypoglycemia : Adult patients taking an insulin secretagogue or insulin may have an increased risk of hypoglycemia, including severe hypoglycemia. (Liraglutide label, Warnings and precautions)

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

Antidiabetic drugs (oral agents and insulin) - dosage adjustment of the antidiabetic drug may be required. (Lisinopril and hydrochlorothiazide label, Drug interactions)

Antidiabetic drugs: dosage adjustment of antidiabetic may be required. (Losartan and hydrochlorothiazide label, Drug interactions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Hypoglycemia with Concomitant Use with Insulin and Insulin Secretagogues : Increased risk of hypoglycemia when used in combination with insulin and/or an insulin secretagogue. (Metformin label, Warnings and precautions)

Antidiabetics : Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. (Methylprednisolone label, Drug interactions)

Insulin Clinical Impact Increased GI motility by metoclopramide may increase delivery of food to the intestines and increase blood glucose. (Metoclopramide label, Drug interactions)

Insulin And Oral Antidiabetic Agents See Glucose Tolerance under PRECAUTIONS , General . (Metolazone label, Drug interactions)

Antidiabetic agents Carefully monitor blood glucose. (Moxifloxacin label, Drug interactions)

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

Use of Antidiabetic Medications: Weight loss may cause hypoglycemia. (Naltrexone and bupropion label, Warnings and precautions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

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. (Ofloxacin label, Warnings)

A reduction in dose of oral hypoglycemic medication (e.g., sulfonylureas) or insulin may be required in some patients [see Clinical Studies (14) ] . (Orlistat label, Warnings and precautions)

• A reduction in dose of insulin or oral hypoglycemic medication may be required in some patients. (Phentermine label, Warnings and precautions)

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

Combination use with insulin and use in congestive heart failure NYHA Class I and II may increase risk. (Pioglitazone label, Warnings and precautions)

Combination use with insulin and use in congestive heart failure NYHA Class I and II may increase risk. (Pioglitazone and metformin label, Warnings and precautions)

Antidiabetic Agents: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. (Prednisolone label, Drug interactions)

Antidiabetic agents: May increase blood glucose concentrations. (Prednisone label, Drug interactions)

Monitor patients for the development of edema when co-administering LYRICA CR and thiazolidinedione antidiabetic agents. (Pregabalin label, Warnings and precautions)

Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method, or add a barrier method of contraception for 4 weeks after initiation with ZEPBOUND and for 4 weeks after each dose escalation. (Tirzepatide label, Drug interactions)

Hypoglycemia: Concomitant use with insulin or an insulin secretagogue may increase the risk of hypoglycemia, including severe hypoglycemia. (Tirzepatide label, Warnings and precautions)

Decrease exposure Digitoxin Decrease exposure Fluoroquinolones Pefloxacin Administered with rifampin 900 mg daily Decrease exposure Moxifloxacin , Decrease exposure Oral Hypoglycemic Agents (e.g., sulfonylureas) Glyburide Decrease exposure Rifampin may worsen glucose control of glyburide. (Rifampin label, Drug interactions)

Some patients required either initiation or dose adjustments of insulin or oral hypoglycemic agents for treatment of these events. (Ritonavir label, Warnings and precautions)

• Hypoglycemia with Concomitant Use of Insulin Secretagogues or Insulin : May increase the risk of hypoglycemia, including severe hypoglycemia. (Semaglutide label, Warnings and precautions)

Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues: Increased risk of hypoglycemia when used in combination with insulin and/or an insulin secretagogue. (Sitagliptin label, Warnings and precautions)

Hypoglycemia with Concomitant Use with Insulin or Insulin Secretagogues: Increased risk of hypoglycemia when used in combination with insulin and/or an insulin secretagogue. (Sitagliptin and metformin label, Warnings and precautions)

Insulin and Oral Antidiabetics Hyperglycemia may occur, and the dosage of insulin or antidiabetic drugs may require adjustment. (Sotalol label, Drug interactions)

Antidiabetic drugs (e.g., oral agents, insulin): Dosage adjustment of the antidiabetic drug may be required (see Precautions ). (Spironolactone and hydrochlorothiazide label, Drug interactions)

Like other sulfonamide-containing drugs, sulfamethoxazole and trimethoprim potentiates the effect of oral hypoglycemics. (Sulfamethoxazole and trimethoprim label, Drug interactions)

- Insulin: In patients with diabetes, concomitant use with KYZATREX® may decrease blood glucose and insulin requirements ( 7.1 ). (Testosterone label, Drug interactions)

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. (Timolol label, Warnings and precautions)

(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. (Trandolapril label, Drug interactions)

Hypoglycemia in Diabetic Patients Some MAOIs have contributed to hypoglycemic episodes in diabetic patients receiving insulin or other blood-glucose-lowering agents. (Tranylcypromine label, Warnings and precautions)

Antidiabetics: Because corticosteroids may increase blood glucose concentrations, dosage adjustments of antidiabetic agents may be required. (Triamcinolone label, Drug interactions)

Infusion of glucose and insulin has also been used to treat hyperkalemia. (Triamterene label, Warnings and precautions)

Oral Hypoglycemic Drugs Concurrent use with chlorpropamide may increase the risk of severe hyponatremia. (Triamterene and hydrochlorothiazide label, Drug interactions)

Hydrochlorothiazide: When administered concurrently, the following drugs may interact with thiazide diuretics: Antidiabetic Drugs (oral agents and insulin) - Dosage adjustment of the antidiabetic drug may be required. (Valsartan and hydrochlorothiazide label, Drug interactions)

• Effect of Smoking Cessation on Other Drugs: Pharmacokinetics or pharmacodynamics of certain drugs (e.g., theophylline, warfarin, insulin) may be altered, necessitating dose adjustment. (Varenicline label, Drug interactions)

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. (Voriconazole label, Drug interactions)

Monitor patients on oral medications dependent on threshold concentrations for efficacy and those with a narrow therapeutic index (e.g., warfarin) when concomitantly administered with ZEPBOUND. (Tirzepatide label, Drug interactions)

Such measures include the intravenous administration of sodium bicarbonate solution or oral or parenteral glucose with a rapid-acting insulin preparation. (Amiloride label, Warnings)

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. (Bupropion label, Warnings and precautions)

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. (Clozapine label, Warnings and precautions)

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 ). (Lovastatin label, Drug interactions)

In an uncontrolled open-label trial of CAPLYTA for up to 1 year in adult patients with stable schizophrenia, the percentages of patients with shifts in fasting glucose and insulin values from normal to high were 8% and 12%, respectively. (Lumateperone label, Warnings and precautions)

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. (Miconazole label, Drug interactions)

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. (Moexipril label, Drug interactions)

Hyperglycemia Hyperglycemia, resulting from the drug’s inhibitory effects on insulin release, has been reported. (Phenytoin label, Warnings and precautions)

…been administered without any adverse drug interaction in limited clinical experience to date with the following: (1) cardiac glycosides– digitalis and digoxin; (2) hypoglycemics–insulin, chlorpropamide, phenformin, tolazamide, and tolbutamide; (3) tranquilizers and sedatives–chlordiazepoxide, diazepam, and phenobarbital; (4) antigout–allopurinol, colchicine,… (Prazosin label, Drug interactions)

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. (Ziprasidone label, Warnings and precautions)

Other interactions: Vardenafil hydrochloride tablets had no effect on the pharmacodynamics of glyburide (glucose and insulin concentrations) and warfarin (prothrombin time or other pharmacodynamic parameters). (Vardenafil label, Drug interactions)