The following substances can increase hypoglycaemia: Combination contraindicated: Miconazole (systemic route, oromucosal gel): Increase the hypoglycaemic effect with possible onset of hypoglycaemic symptoms, or even coma.
Combinations which are not recommended: Phenylbutazone (systemic route): Increase in the hypoglycaemic effect of sulphonylureas (displaces their binding to plasma proteins and/or reduces their elimination).
It is preferable to use a different anti-inflammatory agent, or else warm the patient and emphasise the self-monitoring. Where necessary adjust the dose during and after treatment with the anti-inflammatory agent.
Alcohol: "Antabuse effect", in particular with chlorpropamide, glibenclamide, glipizide and tolbutamine: Increases hypoglycaemic reaction (due to inhibiting compensating reactions), that can lead to the onset of hypoglycaemic coma.
Consumption of alcoholic drinks and of medicinal products containing alcohol should be avoided.
Combinations requiring precautions for use: Potentiation of the blood glucose lowering effect and thus, in some instances, hypoglycaemia may occur when one of the following drugs is taken: Other antidiabetic agents (insulin, acarbose, metformin, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, GLP-1 receptor agonists), beta-blockers, fluconazole, angiotensin converting enzyme inhibitors (captopril, enalapril), H2-receptor antagonists, MAOIs, sulfonamides, clarithromycin and nonsteroidal anti-inflammatory agents.
The following products may cause an increase in blood glucose levels: Combination which is not recommended: Danazol: diabetogenic effect of danazol: If the use of this active substance cannot be avoided, warn the patient and emphasise the importance of urine and blood glucose monitoring.
It may be necessary to adjust the dose of the antidiabetic agent during and after treatment with danazol.
Combinations requiring precautions during use: Chlorpromazine (neuroleptics agent): High doses (>100 mg per day of chlorpromazine): increase blood glucose levels (reduced insulin release). Warn the patient and emphasise the importance of blood glucose monitoring.
It may be necessary to adjust the dose of the antidiabetic active substance during and after treatment with the neuroleptic agent.
Glucocorticoids (systemic route and local route: intraarticular use, cutaneous or rectal preparations) and tetracosactide: Increase in blood glucose levels with sometimes ketosis (reduced tolerance to carbohydrates due to corticosteroids).
Warn the patient and emphasise the blood glucose monitoring, particularly at the start of treatment. It may be necessary to adjust the dose of the antidiabetic active substance during and after treatment with glucocorticoids.
Ritodrine, salbutamol, terbutaline (I.V. route): Increased blood glucose levels due to beta-2-agonist effects.
Emphasise the importance of monitoring blood glucose levels.
If necessary, switch to insulin.
Saint John's Wort (Hypericum perforatum) preparations: Gliclazide exposure is decreased by Saint John's Wort (Hypericum perforatum). Emphasise the importance of blood glucose levels monitoring.
The following products may cause dysglycaemia: Combinations requiring precautions during use: Fluoroquinolones: In case of concomitant use of Diamicron 80 mg and a fluoroquinolone, the patient should be warned of the risk of dysglycaemia, and the importance of blood glucose monitoring should be emphasised.
Combinations which must be taken into account: Anticoagulant therapy (warfarin ...): Sulfonylureas may lead to potentiation of anticoagulation during treatment.
Adjustment of the anticoagulant posology may be necessary.