[Interaction between converting enzyme inhibitors and hypoglycemic sulfonamides or insulin].

POSSIBLE INTERACTIONS

Converting enzyme inhibitors (CEI) can intensify the glucose lowering effect of insulin or sulfonureas. This interaction has been observed in a few clinical cases and studied systematically in regional pharmacovigilance centers. LOW RISK RATE: This interaction occurs in certain patients with well-controlled diabetes who are given a CEI or when CEI dosage is increased. The risk of hypoglycemia in diabetics treated with CEI is very low and can be considered as negligible compared with the benefit of this class of well-tolerated renal-protective antihypertension agents. DRUG DEPENDENT: A larger number of cases of hypoglycemia have been reported with captopril and enalapril, probably because these two CEI have been marketed for a longer period. Captopril may have a stronger hypoglycemia effect than enalapril. It has been demonstrated with hyperinsulin euglycemic clamp that captopril improves sensitivity to insulin in healthy volunteers with normal blood pressure; with enalapril however, the increase in insulin sensitivity is less pronounced and non-significant. AN INDIRECT MECHANISM: Captopril, and to a lesser extent enalapril, indirectly increases insulin sensitivity by increasing circulating kinine which leads to vasodilatation in the muscles and increased glucose uptake in muscle tissue.