Pioglitazone; Repaglinide; Rosiglitazone/Trimethoprim
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Trimethoprim may slow down how quickly your liver processes your antidiabetic medicine.
What might happen:
An increase in the effects of your diabetes medicine may occur and may cause low blood sugar levels.
What you should do about this interaction:
If you experience a sudden onset of cold sweat, dizziness, fatigue, shakiness, rapid heartbeat, nausea, vision changes, confusion, personality change, nervousness, or hunger, contact your doctor. It may be necessary to check your blood sugar levels more often. Your doctor may need to adjust the dose of your diabetes medicine.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Tornio A, Niemi M, Neuvonen PJ, Backman JT. Trimethoprim and the CYP2C8*3 allele have opposite effects on the pharmacokinetics of pioglitazone. Drug Metab Dispos 2008 Jan;36(1):73-80.
2.Jaakkola T, Laitila J, Neuvonen PJ, Backman JT. Pioglitazone is metabolised by CYP2C8 and CYP3A4 in vitro: potential for interactions with CYP2C8 inhibitors. Basic Clin Pharmacol Toxicol 2006 Jul;99(1):44-51.
3.Niemi M, Kajosaari LI, Neuvonen M, Backman JT, Neuvonen PJ. The CYP2C8 inhibitor trimethoprim increases the plasma concentrations of repaglinide in healthy subjects. Br J Clin Pharmacol 2004 Apr;57(4):441-7.
4.Hruska MW, Amico JA, Langaee TY, Ferrell RE, Fitzgerald SM, Frye RF. The effect of trimethoprim on CYP2C8 mediated rosiglitazone metabolism in human liver microsomes and healthy subjects. Br J Clin Pharmacol 2005 Jan; 59(1):70-9.
5.Niemi M, Backman JT, Neuvonen PJ. Effects of trimethoprim and rifampin on the pharmacokinetics of the cytochrome P450 2C8 substrate rosiglitazone. Clin Pharmacol Ther 2004 Sep;76(3):239-49.