Interactions : אינטראקציות

7      DRUG INTERACTIONS
Table 4 presents clinically significant drug interactions with JANUET XR: Table 4: Clinically Significant Drug Interactions with JANUET XR
Carbonic Anhydrase Inhibitors
Clinical Impact:         Carbonic anhydrase inhibitors frequently cause a decrease in serum bicarbonate and induce non-anion gap, hyperchloremic metabolic acidosis. Concomitant use of these drugs with JANUET XR may increase the risk for lactic acidosis.
Intervention:        Consider more frequent monitoring of these patients.
Examples:         Topiramate, zonisamide, acetazolamide or dichlorphenamide.
Drugs that Reduce Metformin Clearance
Clinical Impact:         Concomitant use of drugs that interfere with common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2] / multidrug and toxin extrusion [MATE] inhibitors) could increase systemic exposure to metformin and may increase the risk for lactic acidosis [see Clinical Pharmacology
(12.3)].
Intervention:        Consider the benefits and risks of concomitant use with JANUET XR.
Examples:         Ranolazine, vandetanib, dolutegravir, and cimetidine.
Alcohol
Clinical Impact:         Alcohol is known to potentiate the effect of metformin on lactate metabolism.
Intervention:       Warn patients against alcohol intake while receiving JANUET XR.
Insulin Secretagogues or Insulin
Clinical Impact:        Coadministration of JANUET XR with an insulin secretagogue (e.g., sulfonylurea) or insulin may increase the risk of hypoglycemia.
Intervention:       Patients receiving an insulin secretagogue or insulin may require lower doses of the insulin secretagogue or insulin.
Drugs Affecting Glycemic Control
Clinical Impact:        Certain drugs tend to produce hyperglycemia and may lead to loss of glycemic control.
Intervention:       When such drugs are administered to a patient receiving JANUET XR, 

observe the patient closely for loss of blood glucose control. When such drugs are withdrawn from a patient receiving JANUET XR, observe the patient closely for hypoglycemia.
Examples:         Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid,
sympathomimetics, calcium channel blockers, and isoniazid.