Does nifedipine have a diabetogenic effect?

Fråga: Does nifedipine have a diabetogenic effect?

Sammanfattning: Despite the differenecs in observations of the effects of nifedipine on blood sugar, all investigators agree that patients treated with nifedipine should have their blood sugar monitored, especially when high doses of the drug are given.

Svar: Some studies of nifedipine effects on carbohydrate metabolism and insulin secretion have shown it to be potentially diabetogenic (1,2), while another study found that it had no appreciable effect on glucose tolerance (3).

Bhatnagar (4) reported one case of a patient in whom diabetes got worse and another who developed hyperglycemia during the use of nifedipine. Bhatnagar claims that manufacturers of nifedipine have had no reports of this effect as of April 1984.

Zezulka et al (5) observed hyperglycemia in 3 out of 235 patients treated with nifedipine. All 3 however, have been on long term thiazide therapy which could have been responsible for or contributing to the development of overt diabetes mellitus in these patients. Zezulka also observed a slight but significant increase in non-fasting blood glucose after nifedipine was started in 117 subjects. This effect was not exclusive to the patients treated with thiazides.

The effect of another calcium channel blocker - verapamil on blood sugar has also been studied with the same conclusions: "In man verapamil exerts non-insulin mediated effects on blood glucose which vary during different metabolic and experimental conditions" (6). 1 Giugliano D, Torella R, Cacciapuoti F, Gentile S, Verza M, Varricchio M: Impairment of insulin secretion in man by nifedipine. Eur J Clin Pharmacol 1980; 18: 395-398 2 Charles S, Ketelslegers J-M, Buysschaert M, Lambert AE: Hyperglycaemic effect of nifedipine. Br Med J 1981; 283: 19-20 3 Donnelly T, Harrower ADB: Effect of nifedipine on glucose tolerance and insulin secretion in diabetic and non-diabetic patients. Curr Med Res Opin 1980; 6: 690-693 4 Bhatnagar SK, Amin MMA, Al-Yusuf AR: Diabetogenic effects of nifedipine. Br Med J 1984; 289: 19 5 Zezulka AV, Gill JS, Beevers DG: Diabetogenic effects of nifedipine. Br Med J 1984; 289: 437-438 6 Andersson Dan EH: Effect of verapamil on insulin release and glucose metabolism in man. Diss: Karolinska Institutet, Stockholm, 1984