Drug General Information (ID: DDIXY2ERI7)
Drug Name			Insulin lispro (protamine)		Drug Info		Bismuth subsalicylate		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiabetic Agents				Antidiarrheals
Structure

Mechanism of Insulin lispro (protamine)-Bismuth subsalicylate Interaction (Severity Level: Moderate)
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Insulin lispro (protamine)				Bismuth subsalicylate
Mechanism		Hypoglycemic effects				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 lispro (protamine) and Bismuth subsalicylate

Recommended Action
Management		Close monitoring for the development of hypoglycemia is recommended if these drugs are coadministered with insulin, particularly in patients with advanced age and/or renal impairment. The insulin dosage may require adjustment if an interaction is suspected. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations).

References
1	Asplund K, Wiholm BE, Lithner F "Glibenclamide-associated hypoglycaemia: a report on 57 cases." Diabetologia 24 (1983): 412-7. [PMID: 6411511]
2	Product Information. Apidra (insulin glulisine). Aventis Pharmaceuticals, Bridgewater, NJ.
3	Semel JD, Wortham E, Karl DM "Fasting hypoglycemia associated with disopyramide." Am Heart J 106 (1983): 1160-1. [PMID: 6356848]