Drug General Information (ID: DDI9DZFQ51)
Drug Name			Insulin human (isophane)		Drug Info		Nalidixic acid		Drug Info
Drug Type		Hormones				Small molecule
Therapeutic Class		Insulin/Antidiabetic Agents				Antibiotics
Structure

Mechanism of Insulin human (isophane)-Nalidixic acid Interaction (Severity Level: Major)
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Insulin human (isophane)				Nalidixic acid
Mechanism 1		Antidiabetic agent				Hypoglycemic effects
Key Mechanism Factor 1
		Factor Name		Hypoglycemia
		Factor Description		Hypoglycemia is a condition in which your blood sugar (glucose) level is below the standard range. It causes irregular or rapid heartbeat, pale skin, numbness of the lips, tongue or cheeks, and sweating.
Mechanism Description		Increased risk of hypoglycemia by the combination of Insulin human (isophane) and Nalidixic acid
Antagonize the effect of antidiabetic agents Click to Show/Hide Mechanism Graph
Drug Name		Insulin human (isophane)				Nalidixic acid
Mechanism 2		Antidiabetic agent				Hyperglycemia
Key Mechanism Factor 2
		Factor Name		Antidiabetic agents
		Factor Description		The hypoglycemic effect of antidiabetes may be reduced, leading to higher blood glucose, increased blood glucose fluctuations, and the possibility of hyperglycemic complications
Mechanism Description		Antagonize the effect of Insulin human (isophane) when combined with Nalidixic acid
Mechanism 3		Antidiabetic agent				Hyperglycemic effects
Key Mechanism Factor 3
		Factor Name		Antidiabetic agents
		Factor Description		The hypoglycemic effect of antidiabetes may be reduced, leading to higher blood glucose, increased blood glucose fluctuations, and the possibility of hyperglycemic complications
Mechanism Description		Antagonize the effect of Insulin human (isophane) when combined with Nalidixic acid

Recommended Action
Management		Blood glucose should be closely monitored whenever quinolones are prescribed to diabetic patients, especially if they are elderly, have renal impairment, or are severely ill. Due to the risk of profound and potentially life-threatening hypoglycemia, particular caution is advised during concomitant use of insulin and insulin secretagogues (e.g., sulfonylureas, meglitinides). Patients should also be apprised of the increased risk of hypoglycemia and be alert to potential signs and symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypoglycemia occurs, patients should initiate appropriate remedial therapy immediately, discontinue the quinolone, and contact their physician. alternative antibiotics may need to be considered.

References
1	Park-Wyllie LY, Juurlink DN, Kopp A, et al. "Outpatient gatifloxacin therapy and dysglycemia in older adults." N Engl J Med 354 (2006): 1352-61. [PMID: 16510739]
2	Product Information. Cipro (ciprofloxacin). Bayer, West Haven, CT.
3	Saraya A, Yokokura M, Gonoi T, Seino S "Effects of fluoroquinolones on insulin secretion and beta-cell ATP-sensitive K(+) channels." Eur J Pharmacol 497 (2004): 111-7. [PMID: 15321742]