Medication warnings

Certain veterinary medications for other conditions may seriously affect diabetic patients. Always check with your nurse before taking. This list is provided because some of these medications don't mention their side effects on diabetics in their literature.

Many drugs used in veterinary medicine are also used in human medicine under a differently-trademarked name. Learning the human pharma name (if applicable) or generic name of the drug (same in veterinary & human medicine) can often give you additional information regarding possible side effects and how the drug may affect patients with diabetes. Human pharma drugs provide this information--for some reason, veterinary drugs don't always.

If you are considering alternative or herbal medicine for your diabetic pet, see also Alternative medication warnings.

Warning: Can Be Fatal to Diabetics and Non-Diabetics

Xylitol, a common artificial sweetener, lowers blood sugar dangerously in dogs and sometimes humans, possibly also cats. Some prescription and over-the counter medications, including vitamins and supplements which are made for human use contain Xylitol. Reading labels thoroughly and asking your vet can prevent needless tragedies.

Warnings: May raise blood glucose levels

Heartworm and flea/tick prevention real good info

• Heartworm live inside your heart...love them with tlc

Heartworm is a global problem, with areas on all continents except Antarctica affected and is a disease that is far easier to prevent than to cure. It can affect both cats and dogs.

Should your pet be affected by this, a talk with your vet is in order. Increasing insulin doses to counter this temporary situation may cause hypoglycemia once the systemic medication level has lowered.

The phenomenon also does not mean your pet has ceased to respond to the insulin you currently use. Since there are no formal label warnings, he/she needs to be aware that there are temporary side effects for these drugs which apply to some diabetics.

• The same is true for flea and tick removal products, both professional and over the counter; they are also capable of producing this unwanted effect after use in some diabetic animals.

Other Medications

Adrenal gland: Adrenalin or epinephrine is produced by the medulla, or center (shown at left). Cortisol, or cortisone is produced by the outer, or cortex (shown at right).

Epinephrine, or adrenalin, is a hormone present in all of us; most medical literature refers to it simply as the "fight or flight" hormone. It is what gives one that "extra boost" when needed to either escape danger or stand one's ground.

A common medical use of epinephrine is to combat severe allergic/asthmatic reactions. Many people with life-threatening reactions to things like bee stings, etc., are never without their EpiPen. It's a pre-loaded injection of epinephrine to be used in an emergency.

When someone with diabetes needs treatment with epinephrine, it counters the effects of the insulin and hyperglycemia is the result.

Medication name	Uses
Adrenalin Epinephrine	allergic/asthmatic reactions
Nicotinic Acid Niacin	lowering cholesterol
Phenobarbital Epiphen (UK) Phenytoin Dilantin/Dilantin with Phenobarbital	Epilepsy and other nervous system disorders
Thyroid medications Soloxine	Hormone replacement therapy thyroid disorders
Carbamazepine, Atretol, Carbatrol, Epitol Equetro, Tegretol Apo-Carbamazepine Novo-Carbamaz Nu-Carbamazepine Taro-Carbamazepine	Epilepsy
Phenothiazines many generic and brand names at links	Various uses

Also see below under diuretics/heart medications for some diuretics which can cause hyperglycemia.

Contraindicated: May complicate or even promote diabetes

Urinary Incontinence

Proin, Cystolamine, Propalin, PPA-RD, phenylpropanolamine

Precautions

"Do not use in animals with glaucoma, enlarged prostate, diabetes mellitus, heart problems or high blood pressure."

"Can interfere with insulin dosage for diabetic dogs causing both hypoglycemia and hyperglycemia."

"Talk to your doctor/ vet if you have diabetes and you notice changes in blood glucose levels (hypoglycemia/ hyperglycemia) during therapy with acetaminophen/brompheniramine/phenylpropanolamine."

"Because of its effects in elevating heart rate and blood pressure, phenylpropanolamine should not be used in patients with heart disease or pre-existing high blood pressure. This includes patients with glaucoma, hyperthyroidism, and diabetes mellitus as well as those with certain types of cardiovascular disease."

Steroids

• Oral or injected steroidssuch as cortisol are known to raise blood sugar and even sometimes cause diabetes. Talk to your vet -- sometimes steroids are still the best (or only) treatment for a condition and can be compensated for with known diabetes.
  Inhaled steroids for asthma may be tolerated by diabetics better than oral or injected. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary.

• More brand names for corticosteroids are :
• Prednisone
• Decadron
• Kenalog

One brand name for injectable prednisone (methylprednisolone) is Depo-Medrol.

There is another class of steroids in need of mention here. They are called anabolic steroids, and are related to the male sex hormone, testosterone. Their main uses are for medically supervised weight gain, inappetance, (most commonly Winstrol/Stanozolol),, in treatment of some forms of anemia and cancer.

Anabolic Steroid name	Effects
Winstrol, Stanozolol	insulin dose may need adjustment
Anadrol-50, Anapolon-50, Oxymethalone	insulin dose may need adjustment
Durabolin,Deca-Durabolin, Durabolin-50, Hybolin Decanoate, Hybolin Improved, Durabolin-50, Kabolin, Nandrolone	insulin dose may need adjustment
Oxandrin, Oxandrolone	insulin dose may need adjustment

Many generic and brand name steroid medications, some with photo label links, are found on the Steroids page.

Hormones

The drug Ovaban (megestrol acetate) Ovarid (UK) (progestin--female hormone) is approved for use in dogs to end heat cycles. It has also been prescribed for behavioral problems in both dogs and cats, since it is the opposite of testosterone (male hormone). The drug has also been prescribed for some feline skin conditions. Its use with cats has been proven to cause diabetes much of the time; they are also at risk for developing Addison's disease as a result of the drug . It is contraindicated for use in dogs with diabetes.

These types of hormones, when prescribed for diabetics, can be "double problems". The progestin-type hormones themselves, by nature, raise blood glucose; use of them can also mean the body may begin producing excess growth hormones, which causes insulin resistance.

Antibiotics

The producer of Tequin, Bristol-Meyers Squibb, indicated on May 1, 2006, that it discontinued the manufacturing and distribution of Tequin.

Antiarrhythmics/Heart/High Blood Pressure

Verapamil, (human brand names: Calan, Covera, Isoptin, Verelan), is used to treat irregular heartbeats and hypertension (high blood pressure). Despite there being no information at the preceding link regarding diabetes, this WSAVA 2003 presentation says it has serious hyperglycemic effects in dogs. The conclusion is that it should NOT be used for diabetics, because of its effects on blood sugar levels, possibly inducing hyperglycemic shock. The drug is in the calcium-channel blocker class

Warnings: May have other adverse side effects

Antibiotics

Our pets may be prescribed antibiotics for various reasons, such as a dental procedure or a urinary tract infection. http://thehealthstuff.com

• A common full-spectrum antibiotic given for dental procedures is Clavamox, which is available in both tablet and liquid form. The liquid form is sweet, but the sweetness is from an artificial sweetener and should not affect blood glucose. The pill can be crushed and added to wet food if the animal is difficult to pill. Some animals, like some humans, get diarrhea on antibiotics. This can be minimized by the concurrent administration of a probiotic like Culturelle, which is available at vitamin stores. Consult with your veterinarian on the appropriate amount of probotic for your animal. Some caregivers report higher blood glucose levels while their pet is on antibiotics.

Antibiotic name	Effects
Oxytetracycline Terramycin Terak Engemycin (UK)	low blood sugar hypoglycemia
Chloramphenichol Chloromycetin	low blood sugar hypoglycemia false urine glucose test results

• Another class of drugs used to fight various infections are called Sulfa Drugs. They are often used similarly to antibiotics for this purpose. Sulfa drugs can cause hypoglycemia, even in those without diabetes. They are also capable of altering urine glucose test results.

Sulfa drug name	Effects
Gantrisin Septra Bactrim Albon Chanoprim (UK) Duphatrim (UK) Tribrissen (UK) Trinacol (UK) Trimethoprim/Sulfadiazine SulfamethoxazoleAzulfidine/Sulfasalazine Ormetoprim/Primor more names at link	low blood sugar hypoglycemia false urine glucose test results

Diuretics/Heart Medications

• Heart drug Digoxin and diuretic furosemide (both have many other brand names-table and links below), can interact with insulin.

• Though its primary use is for treatment of diabetes, insulin is useful to both people and pets suffering from an overdose of potassium--too much of it in the blood. The medical term for this is hyperkalemia. Potassium ions enter the cells through glucose--insulin helps bring this life-saving change about.

• Furosemide and other diuretics shown in table below, belong to a class of directics known as loop diuretics. This type of medication can cause hyperglycemia for those with diabetes.

Both digoxin and furosemide drain potassium from the system, along with the excess fluids they are prescribed to eliminate. Not all diuretics have this potassium-robbing action; those which don't are known as potassium-sparing diuretics. These drugs in combination with also necessary insulin can bring about a lower than normal potassium level known as hypokalemia.

The problem can be prevented or solved by a prescription for a potassium supplement (K-Dur is just one brand name).

Drug name	Effects
Digoxin Lanoxin furosemide Lasix Salix Myrosemide Dimazon (UK) Frusecare (UK) Frusedale (UK) other brand names	high blood sugar hyperglycemia
bumantanide Bumex thiazide based diuretics/hypertension medications many at links	high blood sugar hyperglycemia
Diuril hydroDIURIL Esidrix Diamox Hygroton Edicrin	high blood sugar hyperglycemia

• Hypertension drugs known generically as Diazoxide (Brand names: Hyperstat, Proglycem) are used not only for cases of high blood pressure, but also for treating non-diabetic hypoglycemia. This class of medication will raise blood glucose levels.

Beta-blocker name	Effects
Propanolol, Inderal acebutolol, Sectral atenolol, Tenormin betaxolol, Kerlone biprosolol, Zebeta carteolol, Cartrol labetalol, Normodyne metoprolol, Lopressor nadolol, Corgard oxprenolol, Trasicor penbutolol, Levatol pindolol, Visken sotalol, Sotacor timolol, Blocadren	blocks normal hypoglycemia symptoms hypoglycemia events may last longer may increase hyperglycemia risk.
Carvedilol Coreg non-specific Beta-blocker	can cause changes in blood glucose levels

• Propanolol AKA Inderal is a drug used to fight hypertension (high blood pressure) and heart disease in people. The drug belongs to the beta-blocker class. They work by blocking beta receptors in the heart for noradrenaline and adrenaline. Anyone with diabetes using beta-blockers needs to be especially careful, because they also can block some of the normal symptoms of hypoglycemia and may make a hypoglycemic episode last longer. Beta blockers increase the risk of hyperglycemia in those with diabetes.

• Methyldopa, brand name Aldoril, used in treating hypertension. can lower blood glucose levels.

• Verapamil (Calan, Covera, Isoptin, Veralan) See Contraindications above for Antiarrthymics/Heart/High Blood Pressure. Causes hyperglycemia in dogs--can possibly precipitate a hyperglycemic crisis in canine diabetics.

Antidepressants and Other Behavior-Modifying Drugs

Many of the drugs commonly used for people are used for the same purposes in pets. The following medications have been cited as having possible side effects in persons with diabetes:

Drug name	Effects
Prozac, Sarafem Fluoxetine, Reconcile	lowering blood glucose change in insulin needs
Carbamazepine, Atretol Carbatrol, Epitol Equetro, Carbamaz Tegretol Apo-Carbamazepine Novo-Carbamaz Nu-Carbamazepine Taro-Carbamazepine (epilepsy)	increased urine glucose levels
Lithium, Eskalith Lithobid	may either strengthen or weaken the effects of insulin
Phenothiazines many generic/brand names at link	may reduce the blood-glucose lowering effect of insulin.
Anafranil/Clomicalm Clomipramine	may cause hyperglycemia, glycosuria (glucose in urine), polyuria,diabetes mellitus.
Zoloft/Sertraline	may cause hypoglycemia, hypoglycemia reaction, polyuria.
Paxil/Paroxetine	may cause diabetes mellitus, polyuria.
Elavil/Amitriptyline	elevation or lowering of blood glucose levels.
Haldol/Haloperidol	elevation or lowering of blood glucose levels hypoglycemia, hyperglycemia.
Stelazine/Trifluoperazine Compazine/Prochlorperazine	hypoglycemia, hyperglycemia glycosuria (glucose in urine).
Navane/Thiothixene	hypoglycemia, hyperglycemia glycosuria (glucose in urine).
Risperdal/Risperidone	polyuria, polydipsia, diabetes mellitus.

Can Lower Blood Glucose

Drug name	Uses
Phenylbutazone, Butazolidin Butaron	arthritis/pain relief
Chlofibrate, Atromid-S	high cholesterol levels
Aspirin	various pain/discomfort
Coumarin-based anticoagulants Dicumerol	circulatory prevention of blood clots
Dimethyl Sulfoxide, DMSO Domoso, Synotic Rimso-50	skin ulcers/wounds/burns,various other uses

• Alcohol can strengthen the blood glucose-lowering effects of insulin. Though our pets don't use alcohol as people do, there are medications and supplements both by prescription and OTC, which contain alcohol as part of their ingredients. Reading labels carefully and being cautious when using meds containing alcohol can prevent possible hypos.

• Metoclopramide, aka Reglan, Clopra, Maxolon, Octamide, Reclomide is used for GI problems and also to prevent vomiting. "Metoclopramide may accelerate food absorption and thereby alter insulin doses and/or timing of insulin effects."

For antibotics and sulfa drugs which lower blood glucose, see Antibiotics section above.

All heart/hypertension/diuretics, some of which do lower blood glucose levels are also listed above in their own section.

False Testing Results-Urine Glucose

See Urine testing stix, Reading Results for examples of ketodiastix and ketostix color charts.

Possible False Urine Glucose Test Results Antibiotics
Antibiotic/Sulfa drug name	Effects
cephalexin, Keflex Cephorum (UK),Rilexine Cefixime/Suprax Cefotixin/Mefoxin Cefpodoxime Proxetil/SimplicefCefotaxime/Claforan other cephalosporin antibiotics enrofloxacin Baytril	less than accurate (false negatives & positives) urine glucose test results
Gantrisin, Septra Bactrim, Albon Chanoprim (UK) Duphatrim (UK) Tribrissen (UK) Trinacol (UK) more names at link	can alter urine glucose test results
Chloramphenichol Chloromycetin	can produce false urine glucose test results.
Tetracycline Helidac,Sumycin Doxycycline Doryx, Doxy 100 Monodox, Vibramycin Vibra-Tabs, Ronaxan (UK) Doxyseptin (UK)	false urine glucose test results
Penicillin and its derivatives ampicillin carbenicillin ticarcillin penicillin G other names at links	can produce false positive urine glucose test results.

Possible False Urine Glucose Test Results Other Drugs
Acetaminophen (brand names) Tylenol	Common use: Pain reliever.
Aspirin	Common use: Pain reliever. False positives possible (With urine test brand name Clinitest.) False negatives possible (With urine test brand names Clinistix or TesTape.)
Salicylates Pepto-Bismol, etc.	Common use: Diarrhea. False positives possible (With urine test brand name Clinitest.) False negatives possible (With urine test brand names Clinistix or TesTape.)
Phenazopyridine Pyridium, Geridium, Pyridiate, or Urogesic	Common use: Urinary tract infections. False positives possible (With urine test brand name TesTape.) Delayed reactions possible (With urine test brand names Clinistix or TesTape.)
Diazepam (brand names) Valium	Negative. Common uses: Seizures, anxiety, muscle relaxant, appetite stimulant. (With urine tests brand names Diastix and Clinistix.)

Vitamin C Supplements
Possible False Test Results
Blood Chemistry	Decreased blood glucose and cholesterol test levels.
Urine Testing	False high urine glucose test results (With urine test brand name Clinitest).
Urine Testing	False negative urine glucose test results (With urine test brand name Clinistix).
Urine Testing	False negative urine glucose test results With other urine test brand name strips.

Possible False Urine Glucose Test Results-Other Reasons
Moderate Ketones	Negative if glucose is only slightly elevated.
Increased Urine Specific Gravity	Negative.
Decreased Temperature	Negative-refrigerated samples.
Very Concentrated Urine	Negative.
Expired Test Strips	Negative.
Old Urine Sample	Negative. Bacterial metabolism of urine at room temperatures for extended periods.
Contaminated Sample	Positive with oxidant contamination such as bleach or hydrogen peroxide.
Feline Urinary Obstruction	Positive-pseudoglucose.

If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results.

False Testing Results-Urine Ketones

Possible False Urine Ketone Test Results Drugs and Supplements
Valproic Acid (brand names) Depakene, Depakote, Divalproex Sodium	Positive. Common use: Treatment of epilepsy.
Cefixime/Suprax	Positive with nitroprusside-based urine testing. Common use: Antibiotic.
Levadopa Metabolites	Positive with high concentrations.
Tricyclic Ring Compounds	Positive. Common use: Treatment of depression.
Captopril other drugs with free sulfhydryl groups	Positive. Captopril Common use: Hypertension (high blood pressure), various heart conditions, preserving kidney function in diabetic nephropathy.
Phenazopyridine Pyridium, Geridium, Pyridiate, or Urogesic.	Positive. Common use: Urinary tract infections.
Glucocorticoids/Steroids	Positive. Common use: Allergies, replacement therapy, others.
Vitamin C Supplements	Negative.

Possible False Urine Ketone Test Results-Other Reasons
Pigmented Urine	Positive-Any other color except yellow or clear. May be the result of other disease processes.
Dehydration	Positive- lack of fluids can concentrate ketones
Old Urine Sample	Negative-ketones can evaporate rapidly.

Further reading

• Multidrug Sensitivities in Dogs--How They Can Be Gene-Related

• Commonly Used Veterinary Drugs and Dosages By Species
• Therapeutic Drug Monitoring--Tailoring Drug Dosages to the Individual Patient
• Start Page to US Pharmacopeia--Information on Over 9,000 Rx & OTC Drugs
• AnimalHelp.com-Veterinary Drug Database
• Avoiding Adverse Drug Reactions-WSAVA 2001