<p>A number of substances affect glucose metabolism and may require dose adjustment and particularly close monitoring.<br />
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<strong>The following are examples that may increase the blood glucose lowering effect and susceptibility to hypoglycemia</strong>: oral anti-diabetic products, pramlintide and angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, salicylates and sulfonamide antibiotics.<br />
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<strong>The following substances are examples that may reduce the blood glucose lowering effect</strong>: corticosteroids, niacin, danazol, diuretics, sympathomimetic agents, isoniazid, phenothiazine derivatives, somatropin, estrogens, progestogens, atypical antipsychotics and danazol. Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood-glucose-lowering effect of insulin. Pentamidine may cause hypoglycemia, which may sometimes be followed by hyperglycemia.</p>