Pioglitazone with Ginseng Interaction Details
Brand Names Associated with Pioglitazone
- Actoplus Met® (as a combination product containing Metformin, Pioglitazone)
- Actoplus Met® XR (as a combination product containing Metformin, Pioglitazone)
- Actos®
- Duetact® (as a combination product containing Glimepiride, Pioglitazone)
- Oseni® (as a combination product containing Alogliptin, Pioglitazone)
- Pioglitazone
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 02, 2023
Interaction Effect
Increased risk of hypoglycemia
Interaction Summary
An interaction between ginseng and antidiabetic agents has not been reported in the literature to date, but is theoretically possible based on the mechanism of action of ginseng. Content of ginseng products has not been consistent, making adjustment of antidiabetic agents difficult. Studies in patients with diabetes and animal studies suggest that ginseng lowers blood glucose . A reduction in blood glucose has been shown inpatients without diabetes as well, though these patients have not experienced symptomatic hypoglycemia .
Severity
Moderate
Onset
Delayed
Evidence
Theoretical
How To Manage Interaction
Monitor blood glucose closely in patients taking ginseng with antidiabetic agents. In patients having difficulty establishing blood glucose control, it is recommended to avoid concomitant use of ginseng and antidiabetic agents.
Mechanism Of Interaction
Additive hypoglycemic effect
Literature Reports
A) In a randomized, placebo-controlled trial of American ginseng in 10 subjects without diabetes and 9 subjects with Type II diabetes, ginseng significantly lowered blood glucose versus placebo following a glucose challenge. In subjects without diabetes, when American ginseng (3 grams) was given 40 minutes prior to the glucose challenge, blood glucose was significantly lowered at 45 minutes (1.7 +/- 1.2 millimoles/liter (mmol/L) with ginseng versus 2.8 +/- 1.0 mmol/L with placebo) and 60 minutes (0.1 +/- 0.8 mmol/L with ginseng versus 0.8 +/- 1.1 mmol/L with placebo) after the glucose challenge (p less than 0.05). Laboratory reference values were not provided. The change in blood glucose was not significant when ginseng was given at the same time as the glucose challenge. In subjects with Type II diabetes, blood glucose was significantly decreased regardless of the timing of administration of ginseng (p less than 0.05). When ginseng was given at the same time as the glucose challenge, blood glucose at 45 minutes was 4.2 +/- 1.3 mmol/L versus 5.3 +/- 1.3 mmol/L with placebo, and at 60 minutes blood glucose was 3.6 +/- 1.4 mmol/L versus 4.9 +/- 1.5 mmol/L with placebo. When ginseng was given 40 minutes prior to the glucose challenge, blood glucose at 30 minutes was 3.8 +/- 1.2 mmol/L versus 4.8 +/- 0.9 mmol/L with placebo, and at 45 minutes blood glucose was 4.5 +/- 1.1 mmol/L versus 5.3 +/- 1.2 mmol/L with placebo .
B) Asian ginseng (Dansk Droge, Copenhagen) taken daily for 8 weeks decreased fasting blood glucose and hemoglobin A1c in a placebo-controlled, double-blind trial of 36 patients newly diagnosed with non-insulin dependent diabetes mellitus (NIDDM). Ginseng 100 mg daily was found to produce a fasting blood glucose average of 7.4 +/- 1.1 millimole/liter (mmol/L) versus 8.3 +/- 1.3 mmol/L in patients administered placebo (p less than 0.05). The difference in blood glucose with ginseng 200 mg daily did not reach statistical significance (7.1 +/- 1.1 mmol/L versus 8.3 +/- 1.3 mmol/L with placebo). Laboratory reference values were not provided. Hemoglobin A1c was also improved with ginseng 200 mg daily, averaging 6.0 +/- 0.3% versus 6.5 +/- 1.7% in patients treated with placebo (p less than 0.05). The authors concluded that ginseng may be a useful adjunct in the management of NIDDM .
C) In a study of 12 student nurses (ages 21-27) working the night shift, ginseng (1200 mg Korean ginseng administered in two capsules under double-blind, placebo-controlled conditions for three nights) exerted no clinically significant effect on blood glucose levels, although it did decrease the levels. Specifically, the average blood glucose was 5.2 mmol/L in placebo-treated nurses versus 4.5 mmol/L in ginseng-treated nurses. Laboratory reference values were not provided .
D) In a continuation study of 10 subjects with Type 2 diabetes, increased American ginseng doses (up to 9 grams) and alteration of time of administration (from 0 to 120 minutes before glucose challenge) did not affect postprandial glucose to a greater extent than American ginseng 3 grams given 40 minutes prior to glucose challenge .
Pioglitazone Overview
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Pioglitazone is used with a diet and exercise program 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). Pioglitazone is in a class of medications called thiazolidinediones. It works by increasing the body's sensitivity to insulin, a natural substance that helps control blood sugar levels. Pioglitazone 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 develop if high blood sugar is not treated).
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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.
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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:
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.