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Concomitant administration of drugs with own plasma glucose-lowering potential, eg, oral antihyperglycemic, salicylates and pyrazolones, MAOIs, oxytetracycline, ACE inhibitors, derivatives of clofibrate, cyclophosphamide and insulin may cause hypoglycemia.
Beta blockers and sympatholytic drugs like clonidine, reserpine and guanethidine may induce plasma glucose-lowering effects during long-term administration.
The glucose-lowering effect of metformin may be decreased due to concomitant administration of glucocorticoids, oral contraceptives, adrenaline and other sympathomimetics, glucagons, thyroid hormones and phenothiazines. Cimetidine diminishes renal elimination of metformin and concomitant use may produce lactic acidosis.
Concomitant acute and chronic abuse of alcohol may elevate hypoglycemic activity of metformin and production of lactic acid.
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