From the Guidelines
Verapamil ER can cause hypoglycemia when used with certain medications, particularly antidiabetic drugs, and patients should monitor their blood glucose levels more frequently to minimize this risk. The most significant interactions occur with insulin and oral hypoglycemic agents such as sulfonylureas (glipizide, glyburide), metformin, and DPP-4 inhibitors, as noted in recent guidelines on pharmacologic approaches to glycemic treatment 1. When verapamil is combined with these medications, it can enhance their blood sugar-lowering effects, potentially resulting in hypoglycemia.
Some key points to consider include:
- Verapamil's ability to inhibit insulin metabolism and increase insulin sensitivity in peripheral tissues
- The potential for verapamil to impair the body's normal counterregulatory responses to hypoglycemia
- The importance of dose adjustments of diabetes medications when initiating or discontinuing verapamil therapy
- The need for patients to be aware of hypoglycemia symptoms such as confusion, dizziness, sweating, and shakiness
Additionally, other medications like beta-blockers (e.g., propranolol) can also increase the risk of hypoglycemia when used with verapamil, as they may mask the warning signs of low blood sugar while potentially enhancing the hypoglycemic effects, as discussed in the context of glycemic goals and hypoglycemia management 1. Clinicians should be aware of these potential interactions and take steps to mitigate the risk of hypoglycemia in patients taking verapamil ER alongside antidiabetic medications.
From the Research
Verapamil ER Drug Interactions and Hypoglycemia
- Verapamil has been found to have various effects on glucose metabolism and insulin release, which can influence blood sugar levels 2.
- In some cases, verapamil has been used to treat hyperinsulinemic hypoglycemia, suggesting that it may have a role in regulating blood sugar levels 3.
- However, the interaction between verapamil and other medications that can cause hypoglycemia is not well understood.
Medications that May Interact with Verapamil to Cause Hypoglycemia
- Insulin and oral hypoglycemic agents, such as glibenclamide, may interact with verapamil to increase the risk of hypoglycemia 2, 3.
- Other calcium channel blockers, such as amlodipine, may also interact with verapamil to affect blood sugar levels 3.
- The use of verapamil with other medications that can cause hypoglycemia, such as beta blockers and certain antidepressants, may increase the risk of low blood sugar.
Studies on Verapamil and Hypoglycemia
- A study found that verapamil treatment prevented neural damage and memory impairment caused by severe hypoglycemia in rats 4.
- Another study found that calcium channel blocker use, including verapamil, was associated with lower fasting serum glucose levels among adults with diabetes 5.
- A clinical trial found that verapamil treatment improved beta cell function and reduced insulin requirements and hypoglycemic events in adults with recent-onset type 1 diabetes 6.