Drug interaction: Propranolol and Sulfonylureas

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
M

monstersaurous

Full Member
10+ Year Member
15+ Year Member
Joined
Feb 26, 2007
Messages
11
Reaction score
0
Members don't see this ad.
Hi there, I came across this question which asked on the possible drug interactions between propranolol and sulfonylurea secretagogues. Most articles Ive read stopped short at saying that propranolol significantly affects the action of sulfonylureas, without providing much more information.

Does propranolol enhance or diminish the hypoglycemic effect of sulfonylureas, and do they do so by affecting the amount of insulin secreted following sulfonylurea therapy?

Hope I can find some answers to this question. A big thank-you to whoever offers his/her kind opinion on this!
 
So many mechanisms....

Well..lets look at what propranolol does...it's a non selective beta blocker...most people think...ok...lungs...heart...but they forget about the happy little beta-3 receptor...which regulates lipolysis. Inhibit lipolysis...potentially cause hypoglycemia.

Also of note, if the sulfonylurea causes hypoglycemia, the beta blocker can mask the physical symptoms of such...and then you can even get crazy spillover to alpha innervation due to the excess of norepi floating around...

Oh...and beta-2 also regulates glycogenolysis and pancreatic glucogon production...so blocking beta-2 can screw with that, too...inhibiting various mechanisms by which the body can increase endogenous serum glucose levels.

God I miss pharmacology. WTF am I doing in quasiclinical hospital pharmacy, again?
 
Last edited:
WVU is right. Propranolol can potentiate hypoglycemia and it masks hypoglycemia symptoms except sweating since it is a non selective beta blocker. Also, non selective beta blockers can cause a decrease of insulin secretion in diabetes type 2 pts, which may actually cause hyperglycemia.
 
I think the consensus will be there is no direct pharmacodynamic or pharmacokinetic interaction.

Beta blockers will block the bodies normal sympathetic response to hypoglycemia, masking the symptoms and making management more problematic.

While this may be a concern in the management of your average type 2 diabetic, it is certainly not a contraindication.

More information here with the emphasis on:

This interaction is poorly documented and is considered minor in severity.
 
 
BMBiology said:
Also, non selective beta blockers can cause a decrease of insulin secretion in diabetes type 2 pts, which may actually cause hyperglycemia.
Click to expand...

So is the decrease in insulin secretion due to the action of propranolol on beta-2 receptors?
 
http://qjmed.oxfordjournals.org/cgi/content/full/99/7/431

The masking of hypoglycemic symptoms is the biggest concern. Symptoms of the sympathetic nervous system are masked, however like BMBiology pointed out, sweating can still be observed. Also, mental status changes (i.e., irritability, confusion).
 
Sparda29 said:
Hmm, so if propanolol inhibits lipolysis, are there any drugs out there on the market that can jack up lipolysis without causing hyperglycemia?
Click to expand...

CB-1 blockers. Available in Europe...not available in the US. Will lose you a good 20 lbs or so on average. You might commit suicide, however. Hence, it's not FDA approved...
 
Last edited:
I'm not a fan...and here's why. After you cut about 20 lbs or so off of a 350 lbs man....he's still obese....and after 1.5 years or so, the effects on weight tend to plateau. And in order to maintain that new basal metabolism, you have to stay on the drug. You will essentially have people on a maintenance med to stay 20 lbs under their intrinsic weight.

However, it's effects on A1C and lipids may be worth it. They should hurry the hell up and create one that doesn't cross the BBB so that depression doesn't occur.
 
Well as you state it apprently increases HDL among other things, not sure it's such a bad product. The article also says that the adverse events in placebo vs. CB-1 inh were similar, so I don't see this increased suicide risk you're talking about. Got a link?
 
It's the main reason the FDA disn't approve it. Trust me on this one, metabolic pharmacology is pretty much my main scientific interest. I dunno...just google "rimonabant suicide"...tons of news articles...
 
http://www.theheart.org/article/854119.do

Yeah. Well I haven't learned anything about CB receptors yet. But, from an as-yet lay perspective, if the FDA will approve SSRIs with little to moderate benefit for depression despite suicide risks, then I fail to see how a drug with such a good effect on abdominal obesity and HDL levels would not outweigh the risks of increased suicide. I don't know how well determined the links are, but the article I linked seems to suggest it didn't really slow the progression of CAD, unfortunately. So who the **** knows really?

I think it should be part of the repertoire but only used on patients who are then carefully monitored for suicidal ideations.
 
WVUPharm2007 said:
CB-1 blockers. Available in Europe...not available in the US. Will lose you a good 20 lbs or so on average. You might commit suicide, however. Hence, it's not FDA approved...
Click to expand...

That's a small price to pay.....
 
These drugs are toast:

http://www.pharmalot.com/2008/11/sanofi-ends-all-research-into-acomplia-diet-pill/

http://www.pharmalot.com/2008/10/sanofi-aventis-suspends-acomplia-sales-in-europe/

From the EMEA: “..new data from post-marketing experience and ongoing clinical trials indicated that serious psychiatric disorders may be more common than in the clinical trials used in the initial assessment of the medicine,” and that “these psychiatric side effects could not be adequately addressed by further risk minimisation measures…In addition, the effectiveness of Acomplia in clinical practice is more limited than was expected on the basis of the clinical trials, because available data indicate that patients generally take Acomplia only for a short period.”
 
Priapism321 said:
These drugs are toast:

http://www.pharmalot.com/2008/11/sanofi-ends-all-research-into-acomplia-diet-pill/

http://www.pharmalot.com/2008/10/sanofi-aventis-suspends-acomplia-sales-in-europe/

From the EMEA: “..new data from post-marketing experience and ongoing clinical trials indicated that serious psychiatric disorders may be more common than in the clinical trials used in the initial assessment of the medicine,” and that “these psychiatric side effects could not be adequately addressed by further risk minimisation measures…In addition, the effectiveness of Acomplia in clinical practice is more limited than was expected on the basis of the clinical trials, because available data indicate that patients generally take Acomplia only for a short period.”
Click to expand...

WOW

http://www.pharmalot.com/2008/12/pfizer-buys-rights-to-a-drug-to-fix-a-curved-penis/
 
And if you guys really wanted to become educated on rimonabant, just go to the FDA website and pull up the transcripts/powerpoint presentations from the June 13, 2007 advisory committee meeting (Endocrinologic and Metabolic Drugs). The FDA actually has tremendous amounts of useful information on their website, the problem is finding it.

Dr Egan's analysis probably is the most relevant to this discussion.
 
You must log in or register to reply here.

Similar threads

R
Effects of tariffs on drug supply chain?
Replies
1
Views
764
lord999
lord999
Mr.Smile12
[Drug Store News] Trends in pharmacy 2024
Replies
0
Views
1K
Mr.Smile12
Mr.Smile12
Mr.Smile12
[AJPE] The Role of Biomedical and Pharmaceutical Sciences in Pharmacy Education and Practice
Replies
0
Views
1K
Mr.Smile12
Mr.Smile12
Mr.Smile12
[AACP] AACP Statement on NIH Facilities and Administrative Costs Impact on Colleges and Schools of Pharmacy
Replies
1
Views
609
lord999
lord999
PharmDBro2017
Drug Diversion Prevention Software
Replies
2
Views
610
Dred Pirate
Dred Pirate
Top