Diabetes combined with respiratory cardiovascular disease Which drugs can not be used?

Many people with diabetes suffer from other diseases, from colds to cardiovascular diseases. This will involve multiple medications. The mutual reaction of many drugs is really difficult to remember. This issue of Q&A is devoted to drugs that need to be used with caution in diabetic patients.

Diabetes combined with respiratory cardiovascular disease Which drugs can not be used?

When a diabetic patient has a respiratory illness such as a cold, which drugs cannot be used?

Diabetes patients with hypertension, which drugs can not be used?

Diabetes patients with high blood lipids, which drugs can not be used?

Diabetes patients with cardiovascular disease, which drugs can not be used?

Reference answer



When a diabetic patient has a respiratory disease such as a cold

Pay attention when using cold medicine:

(1) Avoid cold medicine containing pseudoephedrine

Pseudoephedrine hydrochloride has the function of contracting blood vessels. It may induce systemic vasospasm after taking, leading to high blood pressure, angina pectoris, myocardial infarction, and severe stroke. Diabetic patients, especially those with cardiovascular and cerebrovascular diseases, hypertension, and kidney disease. It is best to avoid it. If you must take it, you should adjust the dose, such as eating 1/3 tablets at a time, and observe closely.

(2) Drink plenty of water when taking cold medicines containing antipyretic and analgesic ingredients (such as acetaminophen)

The antipyretic effect of these drugs can cause a large amount of sweating and loss of body fluids, causing blood sugar to rise. If the water is not replenished in time, the blood flow will be slowed down, the blood concentration will be hypercoagulable, and the existing vascular lesions will be aggravated. In elderly patients, it is easy to cause intravascular thrombosis, embolism of important tissues and organs, and the consequences are serious. For patients taking exenatide hypoglycemic, acetaminophen should be taken 1 hour before the injection of exenatide.

(3) Avoid using cold medicines containing ethanol

Such as Huoxiang Zhengqi water, Sufi cough syrup, etc., ethanol and hypoglycemic agents have a synergistic effect, which has the risk of causing severe hypoglycemia.

(4) Avoid sugary cold medicine

Such as sugar-containing granules, syrup, honey pill preparations, commonly have acute syrup, Chuanbei glutinous cream, cough syrup and so on. These drugs have high sugar content and are prone to blood sugar fluctuations. They can be selected from sugar-free or corresponding capsules and water pills. Sugar-coated preparations have low sugar content, and non-diabetic patients are contraindicated.

(5) Use cold medicines marked with "use with caution in patients with renal dysfunction"

It may cause or aggravate diabetic nephropathy and increase the difficulty of treatment.

(6) Avoid the use of caffeine-containing cold medicines when using insulin

Caffeine antagonizes the action of insulin by raising epinephrine levels and increasing cAMP concentration in the muscle.

When diabetics have hypertension

1. These antihypertensive drugs should be avoided as much as possible

(1) Non-selective beta blockers

Such as propranolol, it blocks β2 receptors may have adverse effects on sugar and fat metabolism, increase TG, reduce HDL-c, aggravate insulin resistance, increase body mass, mask hypoglycemia, etc., while β2 receptor mediated The vasodilator effect is blocked, aggravating the vascular lesions around the diabetes. Patients with diabetes complicated with hyperthyroidism should also be avoided.

(2) High-dose selective β1 receptor blockers

Common drugs are metoprolol, bisoprolol, atenolol, etc. Selective β1 receptor blockers will decrease in selectivity with increasing dose, adverse reactions are similar to non-selective drugs, and can mask hypoglycemia symptoms. Therefore, it is recommended to use in small doses.

(3) high dose thiazide diuretics

The main drugs are hydrochlorothiazide and indapamide. The adverse effects of thiazide diuretics on glycolipid metabolism were dose-dependent. Small doses (hydrochlorothiazide 6.25-25 mg) had little effect on metabolism. High-dose applications could cause disorders of glycolipid metabolism, electrolyte imbalance, hyperuricemia and Renal blood perfusion is impaired.

(4) alpha blockers

Such as carvedilol, prazosin, doxazosin, etc., such drugs are easy to cause orthostatic hypotension, is not recommended as a routine treatment for diabetes with hypertension, only for severe or refractory hypertension, apply ACEI / ARB For patients with type 2 diabetes who are still unable to meet or cannot tolerate blood pressure after CCB and diuretics, a combination may be considered.

2. These antihypertensive drugs may affect the role of hypoglycemic agents, and blood glucose monitoring should be strengthened when used together.

(1) ACEI

Mainly referred to as captopril, enalapril, they have the effect of lowering blood sugar, may reduce the need for oral hypoglycemic agents or insulin.

(2) CCB, clonidine

These drugs have a tendency to raise blood sugar and may cause blood sugar to go out of control, which may require an increase in the dose of oral hypoglycemic agents or insulin.

Diabetic patients with hyperlipidemia

1. Avoid the combination of these drugs

(1) Repaglinide, pioglitazone + CYP2C8 inhibitor (Gemfibrozil, Gemfizi, etc.)

Studies have shown that, of CYP2C8 inhibitor of gemfibrozil with repaglinide same service, allows the blood of healthy volunteers increased 8.1 times repaglinide AUC, Cmax increased 24 times, t1 / 2 increased from 1.3 hours to 3.7 hours. This may lead to an increase in the hypoglycemic effect of repaglinide and an increase in the duration of action. Therefore, gemfibrozil should be avoided in combination with repaglinide.

There are reports, pioglitazone with gemfibrozil combination therapy results in AUC of pioglitazone increased 3 times. Due to potential dose-related adverse effects, when pioglitazone is combined with gemfibrozil, the amount of pioglitazone needs to be reduced. The recommended maximum dose is 15 mg per day.

(2) Acarbose + cholestyramine

The acarbose instructions indicate "avoid the simultaneous use of coleamide, intestinal sorbent and digestive enzymes to avoid affecting the efficacy of this product."

2. These lipid-lowering drugs may affect the role of hypoglycemic agents, and blood glucose monitoring should be strengthened when used together.

(1) Bet, Probco

Increase the role of hypoglycemic agents, which may reduce the need for oral hypoglycemic agents or insulin. It is known that the fibrate lipid-lowering drugs gemfibrozil, gemfibrozil, bezafibrate, and propolyester have high plasma protein binding rate, and when combined with other high protein binding drugs such as sulfonylureas, They can be replaced from protein binding sites, resulting in enhanced hypoglycemic effects.

(2) niacin preparation

The tendency to raise blood sugar can reduce the effects of hypoglycemic agents, which may require an increase in the dose of oral hypoglycemic agents or insulin.

3. Exenatide may affect the clinical efficacy of statin lipid-lowering drugs, combined or need to adjust the amount of lipid-lowering drugs

Studies, exenatide in combination with lovastatin, lovastatin AUC and Craas reduced by about 40% and 28%, respectively, and the delay about 4 hours. In a 30-week exenatide-controlled clinical trial, patients taking statin lipid-lowering drugs used exenatide injection, and there was no corresponding change in blood lipid levels compared with baseline.

Diabetic patients with cardiovascular disease

1. Patients with warfarin or other coumarin derivatives are recommended for more frequent blood glucose and INR monitoring

It is known that warfarin interacts with various hypoglycemic drugs. For example, metformin increases the anticoagulant tendency of warfarin. Glimepiride may enhance or attenuate the action of coumarin derivatives, and warfarin sodium may increase. The effect of oral sulfonylurea anti-diabetic drugs. Studies have shown that glipizide, pioglitazone, sitagliptin, exenatide and warfarin have no clinically significant interactions, but caution should be exercised in clinical combination.

2. Acarbose may affect the bioavailability of digoxin

The acarbose instructions suggest that "in some cases, acarbose can affect the bioavailability of digoxin, so the dose of digoxin needs to be adjusted."

3. Cationic drugs excreted by the renal tubule may interact with metformin

Such as digoxin, procainamide, quinidine, ampicillin, etc., may theoretically compete with metformin for the renal tubular transport system, and it is recommended to closely monitor and adjust the dose of metformin and or combination drugs.

4. Salicylate and quinidine can promote blood sugar lowering, phenytoin and sympathomimetic drugs have a tendency to raise blood sugar.

It is known that salicylates (such as aspirin) can compete with insulin and plasma proteins. Quinidine can delay the degradation of insulin and increase the level of free insulin in the blood, thereby enhancing its hypoglycemic effect. Phenytoin, sympathomimetic (such as epinephrine, norepinephrine, catecholamine) have a tendency to raise blood sugar, which may lead to loss of control of blood sugar. The combination may require an increase in the dose of hypoglycemic agents or insulin.

Diabetes patients with obesity

The weight-loss drug fenfluramine hydrochloride can synergize with hypoglycemic agents, and should be appropriately reduced when combined with hypoglycemic agents.