Diabetes Drugs: Side Effects

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Prescription Diabetes Medication Side Effects

                                                          

                                                       ANNOUNCEMENT!


Dr. Robert DiSogra has prepared a 90 minute presentation titled:


Audiological Management of Oral and Injectable Medications for Diabetes 


Please contact Dr. DiSogra at bobd1030@aol.com for additional information.

   


Background

There is a wealth of information about the effectiveness of all of FDA-approved medications. However, adverse drug reactions (or side effects) must be viewed more closely in the management of diabetes especially in the area of hearing loss, balance/vestibular function and cognition. See ADDENDUM - Vestibular Toxicity below.

Auditory – Vestibular Side Effects of Diabetes Medications


NOTE 1: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to the rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Also, if one person in 100 reports, say, "tinnitus" (ringing in the ears) while taking this drug then tinnitus must be listed as an adverse reaction. For more information on the incidence figures for all reported side effects you should contact the drug's manufacturer directly.


NOTE 2: Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, blurred vision, fast heartbeat, sweating, tremor, trouble concentrating, confusion, or seizure (convulsions).

  

NOTE 3: None of the 75 medications have tinnitus (ear ringing or other continuous noise) as a reported side effect.



Auditory and Vestibular Related Side Effects Of The 75 FDA Approved Drugs For Diabetes Management  As Well As Those Side Effects That Could Interfere With A Balance Assessment (as of 5/20/19)


compiled by: Robert M. DiSogra, AuD


There are 75 drugs (including oral, injectable and inhalants) for diabetes management (as of 5/20/19).


The following list isolates the auditory and vestibular side effects of these medications. 


Auditory side effects dominate the list (20/75 or 26%). Vestibular side effects (vertigo or spinning) comprise only (2/75 or 3%),  It is of interest to note that 43 of the 75 drugs had a side effect that could affect a balance assessment.


None of the 75 drugs have hearing loss or tinnitus (ringing, buzzing, humming or non-pulsatile noises) as a reported side effect.


This information is critical for audiologists and ENT physicians who are managing auditory/vestibular issues with their diabetic patients.


DISCLAIMER: Not all diabetic patients taking these medications will experience these side effects. The list has been assembled as a guide for the practitioner especially when test results are discrepant. Consult the prescribing physician or pharmacist for additional information (especially when establishing time-lines from when the drug was introduced or the dosage changed. 



Letter code:

A = auditory side effect

V = vestibular side effect 

BAI = Balance Assessment Interference (a side effect that could affect the accuracy of a balance assessment)


NOTE: Several medication side effects list “lightheaded when up getting up suddenly from a lying or sitting position” or “unsteadiness.” Unsteadiness upon rising should most often be associated with orthostatic hypotension which can certainly be a medication side effect. (See References A and B)


Actos (pioglitazone)

A: No

V: No

BAI: Yes - weakness, blurred vision, changes in vision, visual disturbances


Actoplus Met (pioglitazone + metformin)

A: Yes - ear congestion

V: No 

BAI: Yes - weakness, blurred vision


Actoplus Met XR (pioglitazone + metformin)

A: Yes - ear congestion

V: No

BAI: Yes - weakness, blurred vision


Adlyxin (lixisenatide)

A: No

V: No

BAI: Yes - weakness


Admelog – see Humalog


Afrezza (insulin human inhalation powder)

A: No

V: No

BAI: Yes - blurred vision, light-headedness


Amaryl (glimepiride)

A: No 

V: No

BAI: No


Apidra (glulisine)

A: Yes - ear congestion, pounding in the ears

V: No

BAI: Yes - blurred vision, weakness, lightheadedness (when getting up suddenly from a 

      lying or sitting position)


Avandamet (rosiglitazone + metformin)

A: No

V: No

BAI: Yes - blurred vision, weakness


Avandaryl (rosiglitazone + glimepiride)

A: Yes - ear congestion

V: No

BAI: Yes - weakness, blurred vision


Avandia (rosiglitazone)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, changes in vision


Avandia (rosiglitazone maleate)

A: No

V: No

BAI: No


Basaglar (insulin glargine) 

A: No

V: No

BAI: Yes - blurred vision, lightheadedness, puffiness or swelling of the eyelids or around 

     the eyes 


Budureon Extendsed Release (exenatide)

A: No

V: No

BAI: Yes - lightheadedness, weakness


Byetta (exenatide)

A: No

V: No

BAI: Yes - lightheadedness, weakness, blurred vision


Cycloset (bromocriptine)

A: Yes - tingling of the ears

V: Yes - vertigo

BAI: Yes - lightheadedness especially when getting up from a lying or sitting position,   vision  changes, visual disturbances,  visual field defect, weakness


Diaβeta (DiaBeta) (glyburide)

A: No

V: No

BAI: Yes - feeling unsteady, weakness


Diabinese (chlorpropamide) 

A: No

V: Yes - spinning sensation

BAI: Yes - weakness, feeling unsteady, 


Duetact (pioglitazone + glimepiride)

A: Yes - ear congestion 

V: No

BAI: Yes - weakness, blurred vision


Farxiga (dapaglifloxin)

A: No 

V: No

BAI: Yes - blurred vision


Fiasp (aspart recombivant)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, lightheadedness, swelling of the face 


Fortamet Extended Release (metformin)

A: No 

V: No 

BAI: No


Gensulin NPH (isophane insulin)

A: No

V: No

BAI: No


Glucophage (metformin) 

A: No

V: No 

BAI: No


Glucophage XR (metformin) 

A: No

V: No

BAI: No


Glucotrol (glipizide)

A: No

V: No

BAI: No


Glucotrol XL (glipizide)

A: No

V: No

BAI: No


Glucovance (glyburide + metformin)

A: No

V: No

BAI: Yes - blurred vision, weakness


Glumetza (metformin)

A: No

V: No

BAI: No


Glynase Press Tab (glyburide)

A: No

V: No 

BAI: Yes - feeling unsteady, weakness


Glyset (miglitol)

A: No

V: No

BAI: No


Humalog (lispro U-100 and U-200)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a 

         lying or sitting position, puffiness around the eyes, weakness


Iletin II NPH [NPH Iletin II®] (isophane insulin)

A: No

V: No

BAI: No


Invokamet (canagliflozin + metformin)

A: No

V: No

BAI: Yes - weakness, lightheadedness when getting up suddenly, falls


Invokamet XR (canagliflozin + metformin)

A: No

V: No

BAI: Yes - weakness, lightheadedness when getting up suddenly, falls


Invokana (canagliflozin)

A: No

V: No 

BAI: No


Janumet (sitagliptin + metformin) 

A: No

V: No

BAI: Yes - blurred vision, weakness


Januvia (sitagliptin phosphate)

A: No

V: No

BAI: No


Jardiance (empaglifloxin)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a    

                   lying or sitting position, weakness


Jentadueto  (linagliptin + metformin)

A: No

V: No

BAI: Yes - blurred vision


Jentadueto  XR (linagliptin + metformin)

A: No

V: No

BAI: Yes - blurred vision


Kazano (alogliptin + metformin)

A: Yes - ear congestion, pounding in the ears 

V: No

BAI: Yes - blurred vision, weakness


Kombiglyze XR  (saxagliptin + metformin)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision


Lantus (iglargine)

A: No 

V: No

BAI: Yes - blurred vision, weakness


Levemir (detemir [rDNA origin])

A: No

V: No 

BAI: No


Metaglip (glipizide + metformin)

A: Yes - pounding in the ears

V: No

BAI: Yes - blurred vision, dizziness, weakness


Micronase (glyburide)

A: No

V: No

BAI: Yes - feeling unsteady, weakness


Nesina (alogliptin)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, weakness 


Novolog (aspart)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness, weakness


Onglyza (saxagliptin)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, puffy or swollen eyelids


Orinase (tolbutamide)

A: No

V: No

BAI: Yes - weakness


Oseni (alogliptin + pioglitazone)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision


Ozempic (semaglutide)

A: No

V: No

BAI: Yes - blurred vision


PrandiMet (rapaglinide + metformin)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision


Prandin (repaglinide)

A: No

V: No

BAI: No


Precose (acarbose) 

A: No

V: No

BAI: No


Qtern (dapaglinide + saxagliptin)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a lying or 

         sitting position, puffiness or swelling of the eyelids or around the eyes, face


Regular NPH (isophane insulin)

A: No

V: No

BAI: No


Riomet (metformin liquid)

A: No

V: No

BAI: Yes - lightheadedness


SciLin NPH (isophane insulin)

A: No

V: No

BAI: No


Soliqua (lixisenatide/insulin glargine)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a lying or

         sitting position, puffiness or swelling of the eyelids or around the eyes, face, 


Starlix (nateglinide)

A: No

V: No 

BAI: No


Steglatro (ertigliflozin) 

A: No

V: No

BAI: Yes - blurred vision, lightheadedness


Steglujan (ertuglifloxin +sitagliptin)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a lying or 

         sitting position, sunken eyes, puffiness or swelling of the eyelids or around the  eyes,

         face


Symlin (pramlintide)

A: No

V: No

BAI: Yes - blurred vision, weakness


Synjardy (empaglifloxin + metformin)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a lying or 

         sitting position


Synjardy XR (empaglifloxin + metformin)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a lying or 

         sitting position


Tanzeum (albigulitide)

A: Yes - ear congestion

V: No

BAI: Yes - blurred vision, weakness


Tolinase (tolazamide)

A: No

V: No

BAI: Yes - weakness


Toujeo NPH (insulin glargine)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness, puffiness around the eyes


Tradjenta (linagliptin) 

A: No

V: No

BAI: Yes - blurred vision, weakness, puffy or swollen eyelids


Tresiba (insulin degludec injection)

A: No

V: No

BAI: No


Trulicity (dulagulitide)

A: No

V: No

BAI: Yes - facial edema, weakness


Victoza (liraglutide)

A: Yes - ear pounding

V: No

BAI: Yes - weakness, blurred vision, dizziness      


WelChol (colesevelam)

A: Yes - pounding in the ears

V: No

BAI: Yes - blurred vision, weakness

 

Xigduo XR (dapaglifloxin + metformin)

A: No

V: No

BAI: Yes - blurred vision, lightheadedness when getting up suddenly from a lying or 

          sitting position, swelling of the eyelids, face



References


A. Personal communication, Richard Roberts, PhD, Department of Hearing and Speech

        Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University School of Medicine,

        Nashville, TN


B. Personal Communication, Richard Gans. Ph.D., Director, American Institute of 

        Balance, Largo, FL











References

1. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney 

    Diseases National Diabetes Information Clearinghouse. “What I need to know about

    diabetes medicine”     (www.diabetes.niddk.nih.gov)


2. www.rxlist.com


3. www.drugs.com


4. Physician’s Desk Reference, 70th edition, PDR Network, LLC, Montvale, NJ 2016


5. Drug manufacturer's website



Acknowledgements

Dr. DiSogra wishes to thank Jerry D. Meece, RPh, CDE, FACA, FAADE, Clinical Pharmacist and Certified Diabetes Educator for his assistance in the assembling of this list. Dr. Meece is the owner and Director of Clinical Services of Plaza Pharmacy and Wellness Center in Gainesville, Texas. Dr. Meece is also an editor for the American Association of Diabetes Educators in Practice journal.

ADDENDUM - Vestibular Toxicity

 

NOTE: Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to the rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. Also, if one person in 100 reports, say, "tinnitus" (ringing in the ears) while taking this drug then tinnitus must be listed as an adverse reaction. For more information on the incidence figures for all reported side effects you should contact the drug's manufacturer directly.


NOTE: Symptoms of low blood sugar may include headache, nausea, hunger, confusion, drowsiness, weakness, dizziness, blurred vision, fast heartbeat, sweating, tremor, trouble concentrating, confusion, or seizure (convulsions).