Medication warnings

Certain veterinary medications for other conditions may seriously affect diabetic patients. 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.

The criteria for a drug appearing on the human medications list as affecting blood glucose levels is this: the drug is known to have the same effect on the blood glucose levels of someone who doesn't have diabetes. (Who may not have any adverse reactions of either hyperglycemia or hypoglycemia that need to be treated because the non-diabetic has a working pancreas capable of secreting additional insulin and normal counter-regulatory signaling for the body to release extra glucose, whichever may apply.) These effects then have a possibility to be more pronounced when someone with diabetes is taking them. Diabetes In Control has a list of these drugs here.

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

Whenever medication is prescribed, knowing the following when you receive it can make things easier:

• Name of the drug
• Condition the drug is meant to treat
• How the drug is to be given-orally, in the ear or eye, applied to the skin
• When and how often it is to be used
• What to do if you miss a dose
• The effects expected from the drug
• Possible side effects of the drug
• Length of time to give the drug
• If the drug has any special handling or storage requirements (Insulin, for example, is normally refrigerated)
• If there are any problems that may be expected in giving the medication

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.

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." "Talk to your doctor if you have diabetes and you notice changes in blood glucose levels 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."

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). It is contraindicated for use in dogs with diabetes. This drug has another brand name, Megace, and is used in treating some cancers in humans.

Medroxyprogesterone acetate, also known as Provera, Cycrin, Amen, Depo-Provera, and Progestone is a synthetic form of progesterone. There are no veterinary forms of the drug; it is found as a human pharmacy product only and needs to be prescribed off label. It is sometimes used to suppress female heat cycles, animal aggression, and in some cases of male animal behavioral problems such as mounting and humping. It is contraindicated for use in animals 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.

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.

Steroids-Approach with caution

• Oral or injected steroids such 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), and 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

See the steroids page for more information. Many generic and brand name steroid medications, some with photo label links, are found on the Prescribed Steroids page.

Warnings: May raise blood glucose levels

Heartworm and flea/tick prevention

• Heartworm and flea/tick prevention medications are known to produce temporary high blood glucose levels in some diabetic dogs. In the affected animals, glucose levels return to normal a few days after the medication is used--loss of control being temporary.
  Just as all diabetics are not troubled with post-prandial spikes or dawn phenomenon, not all diabetic pets react to these medications in this way. No pharmaceutical company's products of this type contain advisories regarding the temporary elevation of blood glucose.

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 or prevention 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; can also be referred to as a catecholamine.

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
Cyclosporine/Cyclosporin A Gengraf, Neoral, Sandimmune Sandoz Cyclosporine, Restatis (opthalmic)	suppression of immune system due to various medical conditions

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

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.

• 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

Sulfa drugs

• 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, , Duphatrim (UK)  Tribrissen (UK), Trinacol (UK), Trimethoprim/Sulfadiazine Sulfamethoxazole Azulfidine/Sulfasalazine Ormetoprim/Primor more names at link	low blood sugar/hypoglycemia false urine glucose test results

Diuretics/Heart/Hypertension 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/frusemide 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/frusemide 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 frusemide, 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.

The drug Diamox (acetazolamide) shown in the table above can be used to treat glaucoma, seizure disorders as well as some other medical conditions along with heart/hypertension problems. This drug, along with Methazolamide, (Neptazane) dorzolamide, (Trusopt), Brinzolamide (Azopt) and Topiramate are classed as carbonic anhydrase inhibitors, which are capable of causing a loss of blood glucose control and may increase the amount of glucose in the blood and urine of those with diabetes.

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.

Beta blockers have other uses beyond heart and high blood pressure problems; some are used in the treatment of glaucoma: Timolol AKA (Timoptic), (Betimol) (Isatol) is one. Betaxolol AKA Betoptic, Betoptic S, Lokren, Kerlone is another, along with Carteolol (many brand names at the link), as well as Levobunolol (brand names at link), and Metipranlol (brand names at link.) Some of these are for use in the eyes but there are oral forms of them for treating glaucoma also.

Sedatives, anesthesias, analgesics, emetics

Drug name	Effects
Xylazine (Rompun)	change in insulin needs
Dexmedetomidine (Precedex)	change in insulin needs
Medetomidine (Domitor)	change in insulin needs

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, 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.

See Hormones above for information on Medroxyprogesterone acetate, which can also be prescribed for some types of behavioral problems.

Warnings: 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

Some medications and supplements can cause false negative or false positive results when testing urine for glucose.

Possible False Urine Glucose Test Results--Antibiotics
Antibiotic /Sulfa drug name	Effects
cephalexin, Keflex, Cephorum (UK), Rilexine Cefixime/Suprax Cefotixin/Mefoxin Cefpodoxime Proxetil/Simplicef Cefotaxime/Claforan other cephalosporin antibiotics enrofloxacin, Baytril	less than accurate (false negatives & positives) urine glucose test results
Gantrisin, Septra, Bactrim, Albon ,Duphatrim Tribrissen (UK)   |title=Tribrissen|publisher=NOAH Compendium-UK}}</ref>, 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)	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 (urine test brand name Clinitest.) False negatives possible (urine test brand names Clinistix or TesTape.)
Salicylates Pepto-Bismol, etc.	Common use: Diarrhea. False positives possible (urine test brand name Clinitest.) False negatives possible (urine test brand names Clinistix or TesTape.)
Phenazopyridine Pyridium, Geridium, Pyridiate, or Urogesic	Common use: Urinary tract infections. False positives possible (urine test brand name TesTape.) Delayed reactions possible (urine test brand names Clinistix or TesTape.)
Diazepam (brand names) Valium	Negative. Common uses: Seizures, anxiety, muscle relaxant, appetite stimulant. (urine tests brand names Diastix and Clinistix.)

Possible False Test Results--Vitamin C Supplements
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, hydrogen peroxide or formaldehyde.
Cystitis	Positive due to bacterial peroxidases.

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

Some medications and supplements can cause false negative or false positive results when testing urine for 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 or negative lack of fluids can concentrate ketones
samples with high specific gravity and low pH	Positive.
Old Urine Sample	Negative- ketones can evaporate rapidly.
Older opened test strip container	Negative

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.

More Information

• Multidrug Sensitivities in Dogs--How They Can Be Gene-Related VetMed WSU
• Commonly Used Veterinary Drugs and Dosages By Species PetTalk
• Therapeutic Drug Monitoring--Tailoring Drug Dosages to the Individual Patient Boothe, Dawn Merton, 2003, VetMed Auburn University
• Start Page to US Pharmacopeia--Information on Over 9,000 Rx & OTC Drugs
• Veterinary Drug Database  AnimalHelp
• Avoiding Adverse Drug Reactions Trepanier, Lauren, 2001, WSAVA
• Various Novo Insulins Novo Nordisk
  This pdf file contains some information about what medications may interfere with insulin treatment on page 2.
• Drugs That Can Worsen Diabetes Control Diabetes Self-Management-April 2009
• Vetsulin-Insulin Requirement Changes in Dogs Intervet
• Drug-Induced Disorders of Glucose Tolerance Pandit MK, Burke J, Gustafson AB, Minocha A, Peiris AN., 1993, Annals of Internal Medicine
• Cook-Identifying the reasons behind difficult-to-control diabetes in dogs-pages 2-3 Audrey Cook-1 April 2010-DVM 360
• Hormones Which Raise or Lower Blood Glucose Clinical Chemistry