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Bisoprolol Fumarate + Hydrochlorothiazide + Dapagliflozin Propanediol

Moderate 31 published sources

This interaction is documented in this data source.

Bisoprolol Fumarate + Hydrochlorothiazide
Checked as Bisoprolol + Hydrochlorothiazide
Dapagliflozin Propanediol
Checked as Dapagliflozin

2 documented mechanisms

This source documents more than one distinct mechanism for this pair. Each is shown with its own effect, advice and sources rather than merged into one.

  1. Mechanism 1: Synergy

    Moderate

    via Bisoprolol and Dapagliflozin

    What happens

    Sodium-glucose co-transporter 2 (SGLT-2) inhibitors may potentiate the hypotensive effects of diuretics and other antihypertensive agents or vasodilators. Inhibition of glucose and sodium co-transport produces mild diuresis and transient natriuresis, resulting in intravascular volume contraction. Volume depletion-related adverse reactions including hypotension, postural dizziness, orthostatic hypotension, syncope, and dehydration can occur after initiating treatment with SGLT-2 inhibitors, and the risk may be increased with concomitant use of other agents that can lower blood pressure.

    What to do

    Caution is advised if SGLT-2 inhibitors are coadministered with diuretics and other hypotensive agents, particularly in the elderly and patients with impaired renal function. Prior to initiating SGLT-2 inhibitors, volume status should be assessed and corrected, if necessary. Clinical and laboratory monitoring are recommended during therapy, including electrolytes, fluid status, renal function, and blood pressure. If volume depletion occurs, treatment with SGLT-2 inhibitors should be interrupted until the condition is corrected.

    15 sources

    1. "Product Information. Jardiance (empagliflozin)." Boehringer Ingelheim, Ridgefield, CT.
    2. Cerner Multum, Inc. "Australian Product Information." O 0
    3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
    4. "Product Information. Farxiga (dapagliflozin)." Bristol-Myers Squibb, Princeton, NJ.
    5. "Product Information. Invokana (canagliflozin)." Janssen Pharmaceuticals, Titusville, NJ.
    6. "Product Information. Diabinese (chlorpropamide)." Pfizer US Pharmaceuticals, New York, NY.
    7. Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72
    8. Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6
    Show all 15 sources
    1. "Product Information. Glucotrol (glipizide)." Pfizer US Pharmaceuticals, New York, NY.
    2. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60
    3. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6
    4. Barnett AH, Spiliopoulos AJ, Pyke DA, et al "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5
    5. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
    6. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
    7. Jerntorp P, Almer LO, Holin H, et al "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42

  2. Mechanism 2: Synergy

    Moderate

    via Hydrochlorothiazide and Dapagliflozin

    What happens

    Sodium-glucose co-transporter 2 (SGLT-2) inhibitors may potentiate the diuretic and hypotensive effects of thiazides. Inhibition of glucose and sodium co-transport produces mild diuresis and transient natriuresis, resulting in intravascular volume contraction.

    What to do

    Caution is advised during concomitant use of SGLT-2 inhibitors and thiazides, particularly in the elderly and patients with impaired renal function. Prior to initiating SGLT-2 inhibitors, volume status should be assessed and corrected, if necessary. Clinical and laboratory monitoring are recommended during therapy, including electrolytes, fluid status, renal function, and blood pressure. Blood glucose should also be monitored more closely. If volume depletion occurs, treatment with SGLT-2 inhibitors should be interrupted until the condition is corrected.

    16 sources

    1. "Product Information. Steglatro (ertugliflozin)." Merck & Company Inc, Whitehouse Station, NJ.
    2. "Product Information. Invokana (canagliflozin)." Janssen Pharmaceuticals, Titusville, NJ.
    3. "Product Information. Farxiga (dapagliflozin)." Bristol-Myers Squibb, Princeton, NJ.
    4. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
    5. Cerner Multum, Inc. "Australian Product Information." O 0
    6. "Product Information. Jardiance (empagliflozin)." Boehringer Ingelheim, Ridgefield, CT.
    7. "Product Information. Diabinese (chlorpropamide)." Pfizer US Pharmaceuticals, New York, NY.
    8. Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72
    Show all 16 sources
    1. Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6
    2. "Product Information. Glucotrol (glipizide)." Pfizer US Pharmaceuticals, New York, NY.
    3. "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60
    4. Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6
    5. Barnett AH, Spiliopoulos AJ, Pyke DA, et al "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5
    6. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
    7. "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO.
    8. Jerntorp P, Almer LO, Holin H, et al "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42

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