Is Probenecid Safe To Take With Diabetes Medications?
In our latest question and answer, our pharmacist discusses whether or not the gout medication probenecid is safe to use with diabetes medications.
I am trying to ascertain if the gout medicine Probenecid has any warnings of allergic reaction or interaction warning with oral diabetes medicines(metformin, glipizide, etc)? Thanks!
Aug 17, 2022- Probenecid can be used with most diabetes medications but requires doctor monitoring, especially with sulfonylurea drugs like glipizide which may become more potent and increase low blood sugar risk.
- Probenecid works through the kidneys and may not be as effective if you have kidney problems, which is a common complication of diabetes.
- SGLT2-inhibitor diabetes drugs like Jardiance have only minor interactions with probenecid that typically don't require dose adjustments.
Answer
Hello and thanks for your question!
There are certainly some concerns about taking probenecid with certain drugs for diabetes, but there are no major drug interactions. As long as you are monitored appropriately by your doctor, probenecid can be used with most of them.
Before digging in, I do want to mention that probenecid works via the kidneys (it blocks the reabsorption of uric acid), and doesn't work as well if you have reduced kidney function. I mention this because a common complication of diabetes is kidney impairment. It's just something to be aware of.
Having said that, let's go to the drugs.
Probenecid With Metformin And Glipizide
Probenecid is safe to take with metformin, as there is no known drug interaction there. Glipizide is another story.
Glipizide belongs to a class of drugs known as sulfonylureas (or 'SUs' for short). Probenecid has a drug interaction with all sulfonylureas but is generally considered to be moderate. They can be used together, as long as you are monitored.
The specific interaction here is that probenecid can increase the effect of sulfonylureas drugs, making them more potent, which can increase the risk of hypoglycemia (low blood sugar).
Basically, probenecid can inhibit how quickly our kidneys process sulfonylurea drugs and also increases their concentration in the blood (by altering something called protein binding, but I won't get into that here). The point is that the sulfonylurea drugs may simply be more potent when used with probenecid. This interaction includes all sulfonylureas, including:
- Glipizide
- Glyburide
- Glimepiride
Now, probenecid can and certainly has been used safely with these drugs, but the interaction is something to be aware of and you should be monitored by your doctor, especially if you have had problems with your blood sugar dropping too low in the past.
Probenecid With SGLT2-Inhibitors
You didn't mention this drug class in your question, but this diabetes drug class is becoming increasingly utilized, so it's worth touching on.
One drug in this class, Jardiance (empagliflozin), does interact with probenecid, but the interaction is considered to be minor. The interaction is listed specifically in the prescribing information for Jardiance:
In subjects with normal renal function, coadministration of empagliflozin with probenecid resulted in a 30% decrease in the fraction of empagliflozin excreted in urine without any effect on 24-hour urinary glucose excretion.
Probenecid can increase drug levels of Jardiance if given together. This is, again, thought to be a minor interaction that doesn't really require any monitoring or dose adjustment because, unlike sulfonylureas (like glipizide), SGLT2-inhibitors do not cause hypoglycemia (low blood sugar).
Final Words
I hope this answer helped and please be sure to reach back out in the future!
References & sources
- Jardiance Prescribing Information — Boehringer-Ingelheim
Glossary — Terms in This Answer
- Probenecid
- A medication that works through the kidneys to lower uric acid levels in the blood by blocking its reabsorption.
- Reabsorption
- The process where the kidneys take back substances from the urine back into the bloodstream.
- Kidney impairment
- A reduction in how well the kidneys can filter and process waste products from the blood.
- Sulfonylureas
- A class of diabetes medications that work by stimulating the pancreas to release insulin.
- Hypoglycemia
- A condition where blood sugar levels drop too low, which can cause dizziness, sweating, and confusion.
- Protein binding
- The attachment of a drug to proteins in the blood, which affects how much of the drug is available to work in the body.
- SGLT2-inhibitors
- A class of diabetes medications that work by causing the kidneys to remove excess glucose through the urine.
- Renal function
- How well the kidneys are able to filter waste and excess water from the blood.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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