Glipizide with Clarithromycin Interaction Details

Brand Names Associated with Glipizide

Brand Names Associated with Clarithromycin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 12, 2023

Interaction Effect

An increased risk of hypoglycemia

Interaction Summary

Use caution when prescribing clarithromycin in patients taking glipiZIDE as a case of acute hypoglycemia was described following concurrent use of 1000 mg/day of clarithromycin and glipiZIDE in an elderly patient with type 2 diabetes and renal impairment. The postulated mechanism of this interaction was displacement of the sulfonylurea from protein binding sites by the clarithromycin or alterations in drug excretion. In patients receiving these agents together, consider additional blood glucose monitoring and patient counseling about the signs and symptoms of hypoglycemia and actions to take if the patient becomes hypoglycemic.

Severity

Moderate

Onset

Rapid

Evidence

Probable

How To Manage Interaction

Concurrent use of clarithromycin resulted in a case of acute hypoglycemia in an elderly patient with type 2 diabetes receiving glipiZIDE. Therefore, use caution if these agents are used concurrently, particularly in patients with diabetes and mild renal impairment. Consider additional blood glucose monitoring when starting clarithromycin therapy in patients taking glipiZIDE and additional patient education on the signs and symptoms of hypoglycemia.

Mechanism Of Interaction

Displacement of glipiZIDE from protein binding sites or altered glipiZIDE renal clearance

Literature Reports

A) A case report described acute hypoglycemia within 48 hours of initiating clarithromycin in a 72-year-old white male receiving glipiZIDE concurrently. The patient had a history of greater than 10 years of type 2 diabetes and was treated with diet and 15 mg/day of oral glipiZIDE. Co-morbidities included hypertension, atherosclerotic heart disease, and moderate chronic renal failure, with serum creatinine in the 3 to 4 mg/dL range. His last glycosylated hemoglobin reading was 6.1%. Following a diagnosis of bronchitis, he was prescribed 1,000 mg/day of oral clarithromycin. He was brought to the emergency department in a stupor 48 hours later with an blood glucose reading of 20 mg/dL (via Accucheck). Intravenous dextrose was used to reverse the hypoglycemia without incident and the sulfonylurea was discontinued. No further incidents of hypoglycemia were reported. The postulated mechanism of this interaction was displacement of the sulfonylurea from protein binding sites by the clarithromycin or alterations in drug excretion .

Glipizide Overview

• Glipizide is used along with diet and exercise, and sometimes with other medications, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Glipizide is in a class of medications called sulfonylureas. Glipizide lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently. This medication will only help lower blood sugar in people whose bodies produce insulin naturally. Glipizide is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may occur if high blood sugar is not treated).

• Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.

Clarithromycin Overview

• Clarithromycin is used to treat certain bacterial infections, such as pneumonia (a lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the ears, sinuses, skin, and throat. It also is used to treat and prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. It is used in combination with other medications to eliminate H. pylori, a bacterium that causes ulcers. Clarithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria.

• Antibiotics such as clarithromycin will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.