STEPHEN FREED, RPh, Diabetes Educator
Publisher, Diabetes in Control (www.diabetesincontrol.com) and www.diabetes911.net
DAVID JOFFE, RPh, FACA
Editor in Chief, Diabetes in Control (www.diabetesincontrol.com)
GEORGE E. JACKSON, DPh
When we look at drugs that may affect glucose levels, we need to invoke some special rules. There are medicines for other diseases or aliments that can cause hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) in diabetic and nondiabetic patients. These pharmaceuticals may have an even greater effect on those with diabetes and should either be avoided or used with vigilance and with a consideration of changing the amount of the diabetes medication used.
Some medications are found to have a possible effect on the patient with diabetes but can be used more freely. Again, however, vigilance is warranted.
Whenever you start a new medication, it’s important to understand if it might affect your blood sugars. It is therefore important to monitor your glucose levels carefully.
Due to the aggressive reporting requirements of the FDA, new contraindication information is constantly becoming available. Check with your pharmacist on a regular basis. And remember: If you have any questions about how your medicines can affect your blood sugars, be sure to ask your physician or pharmacist.
The effects upon blood sugar of the medications listed here will vary from one person to another, and can be anywhere from negligible to very significant. For each generic name there may be many more brand names than are listed.
Abacavir (Ziagen)
Abacavir + lamivudine, zidovudine (Trizivir)
Acetazolamide (Diamox)
Acitretin (Soriatane)
Albuterol (Proventil, Ventolin)
Albuterol + ipratropium (Combivent)
Ammonium chloride
Amphotericin B (Amphocin, Fungizone)
Amphotericin B lipid formulations IV (Abelcet)
Amprenavir (Agenerase)
Anidulafungin (Eraxis)
Aripiprazole (Abilify)
Arsenic trioxide (Trisenox)
Asparaginase (Elspar)
Atazanavir (Reyataz)
Atenolol + chlorthalidone (Tenoretic)
Atorvastatin (Lipitor)
Atovaquone (Mepron)
Baclofen (Lioresal)
Benazepril + hydrochlorothiazide (Lotension)
Betamethasone topical (Alphatrex, Betatrex, Beta-Val, Diprolene, Diprolene AF, Diprolene Lotion, Luxiq, Maxivate)
Betamethasone +clotrimazole (Lotrisone topical)
Betaxolol Betoptic eyedrops (Kerlone oral)
Bexarotene (Targretin)
Bicalutamide (Casodex)
Bisoprolol + hydrochlorothiazide (Ziac)
Bumetanide (Bumex)
Caffeine (Caffeine in moderation may actually be beneficial in diabetes but in large amounts can raise blood sugar.)
Candesartan + hydrochlorothiazide (Atacand HCT)
Captopril + hydrochlorothiazide (Capozide)
Carteolol (Cartrol oral, Occupress eyedrops)
Carvedilol (Coreg)
Chlorothiazide (Diuril)
Chlorthalidone (Clorpres, Chlorthalidone tablets, Tenoretic, Thalitone)
Choline salicylate (Numerous trade names of aspirin formulations; check label)
Choline salicylate + magnesium salicylate (CMT, Tricosal, Trilisate)
Clobetasol (Clobevate, Cormax, Cormax Scalp Application, Embeline E, Olux, Temovate, Temovate E, Temovate Scalp Application)
Clozapine (Clozaril, FazaClo)
Conjugated estrogens (Cenestin, Enjuvia, Estrace, Estring, Femring, Femtrace, Gynodiol, Menest, Ogen, Premarin, Vagifem)
Conjugated estrogens + medroxyprogesterone (Premphase, Prempro)
Corticosteroids (Numerous trade names; check label)
Corticotropin
Cortisone (Numerous trade names; check label)
Cyclosporine (Gengraf, Neoral, Sandimmune)
Daclizumab (Zenapax)
Decitabine (Dacogen)
Desonide (DesOwen, Tridesilon)
Desoximetasone (Topicort)
Dexamethasone (Adrenocot, Dalalone, Decadron, Decaject, Dekasol, Dexacort, Dexasone, Dexim, Dexone, Dexamethasone Intensol, Hexadrol, Medidex, Primethasone, Solurex)
Dextromethorphan + promethazine (Phenergan with Dextromethorphan, Phen-Tuss DM)
Diazoxide (Proglycem)
Enalapril + hydrochlorothiazide (Vaseretic)
Encainide (Enkaid)
Ephedrine + guaifenesin (Primatene tablets [OTC]. This medication includes ephedrine and guaifenesin. Guaifenesin is not responsible for hyperglycemia.)
Epinephrine (EpiPen, EpiPen Jr, Primatene Mist [OTC])
Esterified estrogens, estrone, estropipate
Esterified estrogens + methyltestosterone (Estratest)
Estradiol, ethinyl estradiol (Alora, Climara, Congest, Delestrogen, Depo-Estradiol, Depogen, Estinyl, Estrace, Estraderm, Estragyn 5, Estragyn LA 5, Estrasorb, EstroGel, Estro-L.A., Gynodiol, Kestrone-5, Neo-Estrone, Menest, Menostar, Ogen, Ogen.625, Ortho-Est, Premarin, Valergen, Vivelle, Vivelle-Dot)
Estradiol + norethindrone (Activella)
Estradiol + norgestimate (Prefest)
Estramustine (Emcyt)
Ethacrynic acid (Edecrin, Sodium Edecrin)
Everolimus (Afinitor, Zortress)
Fluoxetine (Prozac, Sarafem)
Flurandrenolide (Cordran, Cordran SP, Cordran Tape)
Formoterol (Foradil Aerolizer Inhaler)
Fosinopril + hydrochlorothiazide (Monopril HCT)
Furosemide (Lasix)
Gemtuzumab ozogamicin (Mylotarg)
Glucosamine (Possible increase in insulin resistance; more likely with intravenous use.)
Hydrochlorothiazide (Aldactazide, Aldoril, Capozide, Dyazide, HydroDIURIL, Inderide, Lopressor HCT, Maxzide, Microzide, Moduretic, Timolide, Vaseretic)
Hydrochlorothiazide + irbesartan (Avalide)
Hydrochlorothiazide + lisinopril (Prinzide, Zestoretic)
Hydrochlorothiazide + losartan (Hyzaar)
Hydrochlorothiazide + metoprolol (Lopressor HCT)
Hydrochlorothiazide + moexipril (Uniretic)
Hydrochlorothiazide + quinapril (Accuretic, Quinaretic)
Hydrochlorothiazide + telmisartan (Micardis HCT)
Hydrochlorothiazide + valsartan (Diovan HCT)
Hydrocortisone (Numerous trade names of topical hydrocortisone formulations; check label)
Indapamide (Lozol)
Indinavir (Crixivan)
Interferon alfa-n1 (Alferon-N)
Interferon alfa-2a (Roferon-A)
Interferon alfa-2b (Intron-A)
Interferon alfa-2b + ribavirin (Rebetron)
Irinotecan (Camptosar)
Isoniazid (Laniazid, Nydrazid)
Isotretinoin (Accutane)
Lamivudine (Epivir, Epivir-HBV)
Levalbuterol (Xopenex, Xopenex HFA)
Levonorgestrel (Norplant System, Plan B)
Levothyroxine (Levoxyl, Synthroid)
Liothyronine (Cytomel)
Lopinavir + ritonavir (Kaletra)
Magnesium salicylate (Bayer Select Backache Pain Formula, Doan’s Pills, Mobidin, Nuprin Backache Caplet)
Medroxyprogesterone (Depo-Provera, Provera)
Megestrol (Megace)
Methylprednisolone (A-methaPred, ADD-Vantage, Depo-Medrol, Medrol, Medrol Dosepak, Meprolone Unipak, Solu-Medrol)
Metolazone (Mykrox, Zaroxolyn)
Metoprolol (Lopressor, Lopressor HCT, Toprol XL)
Modafinil (Provigil)
Moxifloxacin (Avelox, Avelox I.V.)
Nadolol (Corgard)
Nelfinavir (Viracept)
Niacin, niacinamide (Niacor, Niaspan, Nicolar, Nicotinex, Slo-Niacin)
Nilotinib (Tasigna)
Nilutamide (Nilandron)
Nitric oxide (INOmax)
Norethindrone (Aygestin, Micronor, Nor-QD)
Norgestrel (Orvette)
Nystatin (Mycostatin, Nystat-Rx, Nystop, Pedi-Dri)
Nystatin + triamcinolone (Dermacomb, Myco II, Mycobiotic II, Mycogen II, Mycolog II, Myco-Triacet II, Mykacet, Mykacet II, Mytrex, Tristatin II)
Octreotide (Sandostatin, Sandostatin LAR)
Olanzapine (Zyprexa)
Pantoprazole (Protonix, Protonix I.V.)
Pegaspargase (Oncaspar)
Peginterferon alfa-2b (PEG-Intron)
Pentamidine (Pentam 300)
Phenylephrine* (Sudafed PE and others)
Phenytoin (Dilantin, Dilantin-125, Dilantin Infatabs, Dilantin Kapseals, Phenytek)
Prednisolone (AK-Pred, Blephamide, Blephamide Liquifilm, Delta Cortef, Econopred Plus, Inflamase Forte, Inflamase Mild, Pediapred, Poly-Pred Liquifilm, Pred Forte, Pred-G, Pred-G Liquifilm, Pred Mild, Prelone)
Prednisone (Prednisone Intensol, Sterapred, Sterapred DS)
Progesterone (Prometrium)
Pseudoephedrine‡(Claritin D, Sudafed, and others)
Quetiapine (Seroquel)
Risperidone (Risperdal, Risperdal M-TAB)
Ritodrine (Yutopar)
Ritonavir (Norvir)
Rituximab (Rituxan)
Salmeterol (Serevent, Serevent Diskus)
Salsalate (Argesic-SA, Disalcid, Mono-Gesic, Salflex, Salsitab)
Saquinavir (Invirase)
Sodium oxybate (Xyrem)
Somatropin (Genotropin, Genotropin Miniquick, Humatrope, Norditropin cartridges, Norditropin NordiFlex, Nutropin, Nutropin AQ, Saizen, Serostim, Zorbtive)
Sotalol (Betapace, Betapace AF, Sorine)
Streptozocin (Zanosar)
Tacrolimus (Prograf, Protopic)
Temsirolimus (Torisel)
Thyroid (Armour Thyroid, Nature-Throid)
Tipranavir (Aptivus)
Tolvaptan (Samsca)
Torsemide (Demadex, Demadex Oral)
Triamcinolone (Aristocort, Aristospan, Asthmacort, Flutex, Kenalog, Tac, Triacet)
Ursodeoxycholic acid, ursodiol (Actigall, Urso)
Valproic acid, divalproex sodium (Depacon, Depakene, Depakene Syrup, Depakote, Depakote ER, Depakote Sprinkle)
Vitamin C (ascorbic acid, ascorbate)
Vitamin E (tocopherol, tocotrienol)
Ziprasidone (Geodone)
Acebutolol (Sectral)
Acetohexamide (Dymelor)
Alcohol
Aloe (Oral herbal supplement, especially if taken with other agents such as glimepiride, glipizide, glyburide, insulin, nateglinide, or repaglinide)
Amphotericin B (Abelcet, AmBisome, Amphocin, Amphotec, Fungizone Intravenous)
Amphotericin B lipid formulations (Abelcet, AmBisome)
Asian ginseng (ginseng; Panax ginseng)
Aspirin (Numerous trade names; check label)
Aspirin + dipyridamole (Aggrenox)
Atenolol (Tenoretic [containing atenolol and chlorthalidone], Tenormin)
Betaxolol (Betoptic, Betoptic S eyedrops, Kerlone oral)
Bisoprolol (Zebeta)
Bisoprolol + hydrochlorothiazide (Ziac)
Bromocriptine (Cycloset)
Chloramphenicol (Chloromycetin)
Chlorpropamide (Diabinese)
Choline salicylate (Acuprin 81, Amigesic, Anacin caplets and tablets, Anacin Maximum Strength, Anaflex 750 Arthritis Pain, Ascriptin Arthritis Pain)
Choline salicylate + magnesium salicylate C (MT, Tricosal, Trilisate)
Chromium (Numerous trade names; check label)
Clarithromycin B (Biaxin Filmtab, Biaxin Granules, Biaxin XL Filmtab, Biaxin XL Pac, Prevpac)
Diazoxide (Proglycem)
Dicumarol (Coumadin, Miradon)
Diltiazem (Cardizem, Tiazac)
Disopyramide (Norpace, Norpace CR)
Dorzolamide + timolol (Cosopt)
Exenatide (Byetta)
Fluoxetine (Prozac, Sarafem)
Fosphenytoin (Cerebyx, Dilantin, Dilantin-125, Dilantin Infatabs, Dilantin Kapseals, Mesantoin, Peganone, Phenytek)
Gamma Globulin, IV only (many brands)
Glimepiride (Amaryl)
Glimepiride + rosiglitazone (Avandaryl)
Glipizide (Glucotrol, Glucotrol XL)
Glipizide + metformin (Metaglip)
Glyburide (Diabeta, Glycron, Glynase, Micronase)
Glyburide + metformin (Glucovance)
Horse chestnut (Aesculus hippocastanum)
Hydrochlorothiazide + metoprolol (Lopressor HCT)
Insulin (Apidra, Humalog, Humulin, Lantus, Levemir, Novolin, Novolog, NPH)
Interferon beta-1b (Betaseron)
Levofloxacin (Levaquin, Levaquin in Dextrose Injection Premix, Quixin)
Liraglutide (Victoza)
Magnesium salicylate (Bayer Select Backache Pain Formula, Doan’s Pills, Mobidin, Nuprin Backache Caplet)
Metformin (Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet)
Metoprolol (Lopressor, Lopressor HCT, Toprol XL)
Morphine (Kadian, MS Contin, MSIR, Roxanol)
Nadolol (Corgard)
Nateglinide (Starlix)
Nifedipine (Adalat CC, Afeditab CR, Procardia)
Octreotide (Sandostatin, Sandostatin LAR Depot)
Paloperidone (Invega)
Penicillamine (Cuprimine, Depen)
Pentamidine (Nebupent, Pentam 300)
Phenelzine (Nardil)
Phenytoin (Dilantin, Dilantin-125, Dilantin Infatabs, Dilantin Kapseals, Phenytek)
Pindolol (Visken)
Pioglitazone (Actos. Hypoglycemia usually only when in combination with other diabetic drugs such as sulfonylureas or insulin.)
Pioglitazone + glimepiride (Duetact. The glimepiride component of this drug gives it the possibility of causing hypoglycemia alone or in combination with other diabetes medicines. This is more likely to occur when one skips a regular meal or when unusual physical activities occur.)
Pioglitazone + metformin (ACTOplus Met, ACTOplus Met XR)
Pramlintide (Symlin)
Probenecid (Benemid, Probalan)
Quinine (Quinamm, Quindan, Quiphile, Q-vel, Strema)
Quinupristin + dalfopristin (Synercid)
Repaglinide (Prandin)
Repaglinide + metformin (PrandiMet)
Ritodrine (Yutopar)
Rituximab (Rituxan)
Rosiglitazone (Avandia)
Rosiglitazone + metformin (Avandamet)
Rotigotine (Neupro)
Salicylates (Numerous trade names of aspirin formulations; check label)
Salsalate (Argesic-SA, Disalcid, Mono-Gesic, Salflex, Salsitab)
Saxagliptin (Onglyza)
Selegiline (Eldepryl)
Sitagliptin (Januvia)
Sitagliptin + metformin HCL (Janumet)
Sodium ferric gluconate complex (Ferrlecit)
Somatropin (Genotropin, Genotropin Miniquick, Humatrope, Norditropin cartridges, Norditropin NordiFlex, Nutropin, Nutropin AQ, Saizen, Serostim, Zorbtive)
Sotalol (Betapace, Betapace AF, Sorine)
Streptozocin (Zanosar)
Sulfadiazine (Microsulfon)
Tacrolimus P (Prograf, Protopic)
Tetracaine (Altacaine, Pontocaine, Tetcaine)
Theophylline (Theo-24, TheoCap, Theo-Dur)
Timolol (Timoptic, Timoptic-XE)
Tolazamide (Tolinase)
Tolbutamide (Orinase)
Tranylcypromine (Parnate)
Varenicline (Chantix)
Verapamil (Calan, Calan SR, Isoptin SR, Verelan)
Amphotericin B (Abelcet, AmBisome, Amphocin, Amphotec, Fungizone Intravenous)
Amphotericin B lipid formulations (Abelcet, AmBisome)
Betaxolol Betoptic eyedrops, (Kerlone oral)
Bisoprolol + hydrochlorothiazide (Ziac)
Choline salicylate (Numerous trade names of aspirin formulations; check label)
Choline salicylate + magnesium salicylate (CMT, Tricosal, Trilisate)
Darunavir (Prezista)
Diazoxide (Proglycem)
Fluoxetine (Prozac, Sarafem)
Hydrochlorothiazide + metoprolol (Lopressor HCT)
Lanreotide acetate (Somatuline)
Lithium (Eskalith, Eskalith CR, Lithobid)
Magnesium salicylate (Bayer Select Backache Pain Formula, Doan’s Pills, Mobidin, Nuprin Backache Caplet)
Mecasermin (Increlex)
Mecasermin rinfabate (Iplex)
Metoprolol (Lopressor, Lopressor HCT, Toprol XL)
Nadolol (Corgard)
Octreotide (Sandostatin, Sandostatin LAR Depot)
Pazopanib (Votrient)
Pentamidine (Nebupent, Pentam 300)
Phenytoin (Dilantin, Dilantin-125, Dilantin Infatabs, Dilantin Kapseals, Phenytek)
Rifampin (Rifadin, Rimactane)
Ritodrine (Yutopar)
Rituximab (Rituxan)
Salsalate (Argesic-SA, Disalcid, Mono-Gesic, Salflex, Salsitab)
Somatropin (Genotropin, Genotropin Miniquick, Humatrope, Norditropin cartridges, Norditropin NordiFlex, Nutropin, Nutropin AQ, Saizen, Serostim, Zorbtive)
Sotalol (Betapace, Betapace AF, Sorine)
Streptozocin (Zanosar)
Sunitinib (Sutent)
Tacrolimus P (Prograf, Protopic)
Atenolol (Tenoretic [containing atenolol and chlorthalidone], Tenormin)
Carteolol (Cartrol oral, Occupress eyedrops)
Carvedilol (Coreg, Coreg Tiltabs)
Clonidine (Catapres, Catapres-TTS-1, Catapres-TTS-2, Catapres-TTS-3, Duraclon)
Metoprolol (Lopressor, Lopressor HCT, Toprol XL)
Nadolol (Corgard)
Nebivolol (Bystolic)
Pindolol (Visken)
Propranolol, propranolol hydrochloride (Inderal, Inderal LA, Inderide, Innopran XL, Intensol)
Timolol (Timoptic, Timoptic-XE)
Because of the constantly changing nature of the U.S. prescription and OTC drug marketplace, this list may not reflect the full range of drugs that may impact blood glucose levels. The information contained in this document is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor before taking any prescription or over-the-counter drugs (including any herbal medicines or supplements) or following any treatment or regimen.