WebMD Ask the Pharmacist

Diabetes Care: Ask the Pharmacist

Pharmacist Macary Marciniak, PharmD, BCPS, answers your questions about diabetes care.

Question:

I’m taking metformin for diabetes. What kind of OTC pain medicine can I take for a headache?

Answer:

For people with diabetes, it is so important to check for interactions between your prescription medications and any nonprescription medications before use. The best choice for your headache would be acetaminophen (Tylenol). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) or naproxen (Aleve), can put a strain on your kidneys, which could already be happening because of your diabetes. I would first try the acetaminophen and see if that works. If not, then you may be able to use an NSAID. But you should check with your doctor first to ensure that your kidneys are functioning well.

Question:

My doctor has put me on Diovan and Diovan HCT for my high blood pressure. I am also a diabetic. Could the Diovan and the Diovan HCT be causing me to feel weak, like I'm going to fall, and to see very bright lights?

Answer:

This is a very serious issue. I think that there could be some confusion or miscommunication regarding your medications. Diovan and Diovan HCT are very similar. Diovan contains valsartan, an angiotensin receptor blocker (ARB). Diovan HCT is a combination medication that contains both valsartan and hydrochlorothiazide, which is a diuretic. No one should be taking both Diovan and Diovan HCT together. You would be taking twice the maximum recommended amount of valsartan! Certainly taking both of these medications would cause dizziness, drowsiness, and low blood pressure, which might cause you to feel weak or like you're going to faint.

Please contact your health care provider immediately. One of these medications should be stopped. Your health care provider might want to see you right away to resolve this issue with your medications.

Question:

I am currently taking glimepiride for my diabetes. What over-the-counter cough and congestion medicines are safe for me to take with glimepiride?

Answer:

For people with diabetes, it is so important to check for interactions between your prescription medications and any nonprescription medications -- such as cough and cold medicines -- before use. When treating cough and cold symptoms, pharmacists and health care providers try to match a person’s symptoms to the appropriate active ingredients. For instance, a cough may be due to a runny nose. In this case, an antihistamine, like chlorpheniramine (Chlor-Trimeton), would be a good option. If the cough is dry and irritating at night, then dextromethorphan (Delsym) can help quiet your cough so you can sleep. To relieve congestion from a cold, one of the best things you can do is get plenty of water. Drinking lots of water can help to break up phlegm.

There is an active ingredient in some cough and cold products called guaifenesin. These kinds of products are a possible choice for relieving chest congestion and are safe for people with diabetes.

I would not recommend any products that contain pseudoephedrine or phenylephrine (Sudafed or Sudafed PE). These medications can increase the blood pressure, which can be concern for people with diabetes. Using pseudoephedrine or phenylephrine for just a couple of days may not be a problem. But avoiding them all together is the safest route. For nasal congestion, I would suggest a saline nasal spray; completely safe for someone with diabetes and just as effective as pseudoephedrine or phenylephrine. Please talk with your pharmacist before taking any cough and cold medications.

Question:

My stepdad has diabetes and currently has a fever. What can we use to lower his fever?

Answer:

For people with diabetes, the fever reducer of choice is acetaminophen (Tylenol). NSAIDs, such as ibuprofen (Advil or Motrin) or naproxen (Aleve), can put a strain on the kidneys.

Question:

I am a 68-year-old woman with diabetes. I'm having terrible stomach pains, along with gas and bloating. Is there an over-the-counter medication that I can take?

Answer:

Gas and bloating are common stomach complaints, and there are few choices to help relieve these symptoms. The best active ingredient is simethicone, which is commonly found in Gas-X.

Over time, some people with diabetes develop gastroparesis, which can make a person's stomach feel full, like it's taking a long time to digest food. If you find that you often feel this way, you may want to talk with your health care provider as the stomach pains may be something more serious.

Question:

I was diagnosed with type 2 diabetes and I also have BPH. I am taking metformin for my diabetes and Cardura for my BPH. My doctor switched me to Rapaflo for my BPH. My blood sugar usually averages 134. Since I started using Rapaflo my blood sugar number is 154. Can Rapaflo be elevating my blood sugar?

Answer:

Rapaflo is not known to cause any problems with blood sugar. I would not attribute the change in blood sugar control to this medication. It's important to consider any other prescription or nonprescription medications you may be taking, as well as any recent changes in your diet. Talk with your pharmacist or health care provider to investigate further.

Question:

I have diabetes and I'm currently taking two pills of ferrous sulfate 325 mg a day. My blood sugar readings are out of control, ranging from 200 to 300. Could the iron be the cause this?

Answer:

Iron is not known to cause any problems with blood sugar. I would not necessarily attribute the change in your blood sugar control with this medication. It is important to consider any other prescription or nonprescription medications you may be taking, as well as any other recent changes in your diet. Talk with your pharmacist or health care provider to investigate further.

Question:

My mom takes lovastatin and was told to take an aspirin every day, as well. Now she has diabetes. Are there any adverse side effects to taking lovastatin and/or aspirin?

Answer:

Lovastatin is a prescription medication, called a statin, for cholesterol. Statin medications are great for lowering the bad cholesterol levels (LDL) and can reduce the risk for heart attack and stroke. Aspirin also helps prevent heart attack and stroke. So these medications may have been helpful before your mom had diabetes. Now that she has been diagnosed with diabetes, there are even more medications that could be helpful.

The most common side effect of lovastatin is muscle pain that doesn't seem to go away. This is rare. But if she experiences it, she should let her health care provider know. The most common side effect of aspirin is bruising or bleeding. These side effects can be reduced by lowering your dose (81 mg). Aspirin can also upset your stomach, so I suggest taking an enteric-coated form along with food. Thanks for your question!

Question:

Can you mix prescription ibuprofen with diabetes medications?

Answer:

For people with diabetes, it is so important to check for interactions between your diabetes medications and any prescription or nonprescription medications before use. Ibuprofen can put a strain on your kidneys, which could already be happening because of your diabetes. If your doctor has prescribed ibuprofen, he most likely checked your kidney function first, and knows that the ibuprofen is safe for you to use. While taking prescription ibuprofen, it's important not to take any nonprescription NSAIDs, such as medications that contain ibuprofen or naproxen (Aleve).

Question:

I’m taking Actoplus Met XR for diabetes. Is there a generic version that is cheaper?

Answer:

Actoplus Met XR is a brand-name medication. It is an extended release formulation that contains both pioglitazone and metformin. It is not available as a generic. However, there are other combination medications for diabetes that are available in generic forms. These options include glyburide and metformin (Glucovance) and glipizide and metformin (Metaglip). Talk with your health care provider. Perhaps one of these medications may be an option for you to lower your blood sugar and reduce your out-of-pocket expenses.

Question:

I have type 2 diabetes and was wondering whether or not Osteo Bi-Flex could raise my blood sugar.

Answer:

Osteo Bi-Flex is a dietary supplement that can help improve joint comfort. There are a couple of different formulations of Osteo Bi-Flex. But most contain glucosamine as one of the ingredients. It is possible that glucosamine can raise your blood sugar. If your health care provider is comfortable with you using Osteo Bi-Flex long-term, you should be able to adjust the dose of your diabetes medication to keep your blood sugar under control.

Question:

My daughter takes metformin for her diabetes. One of the side effects is stomachache. Is there anything she can eat to relieve her stomach aches and frequent bowl movements?

Answer:

Metformin is a very effective at managing blood sugar for people with diabetes. Some of the common side effects are nausea and diarrhea, especially when the medication is first started. To minimize these problems, it is best to take metformin with food. It is also good to start with a lower dose and slowly increase your dosage as your body gets used to the medication.

For many people, the nausea and diarrhea go away shortly after starting metformin. If your daughter has just started the medication, I'd encourage her to stick it out a while longer and give her body a chance to adjust. If she hasn’t been taking it with food, she should do so. If the symptoms don't get any better, talk with her health care provider. Her doctor may decrease her dosage and then slowly increase it as she adjusts. Or another prescription may be given that won’t have the same side effects.

Question:

I take Glucophage for diabetes and Benicar for high blood pressure. Is it OK to take the two together, or should I be taking them separately?

Answer:

Glucophage is a brand name for metformin. Benicar is a brand name for olmesartan. Many individuals with diabetes are on both of these medications. It is completely safe to take these medications together. It's best to take metformin with a meal, to lower the likelihood of side effects like nausea or diarrhea. Benicar can be taken in the morning or in the evening, with or without food. If taking them together helps you remember to take them, you're certainly safe in doing so.

Question:

I take metformin, 500 mg per day. I also take phentermine that was prescribed to me way before I was diagnosed with type 2 diabetes. Is it safe to take those two pills together?

Answer:

Metformin helps lower your blood sugar. Phentermine is a medication to help with weight loss. It is safe to take both of these medications at the same time. It's best to take metformin with a meal, to lower the likelihood of side effects like nausea or diarrhea. You can take your metformin with breakfast, lunch, or dinner; whenever it's easiest for you to remember. Phentermine is best taken before breakfast, or 1 to 2 hours after breakfast. Phentermine should not be taken later in the day, as it can sometimes cause insomnia. It is very important to monitor both your blood sugar and your blood pressure while on both medications.

Question:

Can a person with type 2 diabetes take NyQuil?

Answer:

NyQuil is a nonprescription cough and cold product that is available in a number of different formulations. It typically contains an antihistamine, a cough suppressant, and a pain reliever/fever reducer. All of these active ingredients should be safe for a person with diabetes. People with diabetes should avoid medications that contain pseudoephedrine or phenylephrine, which are decongestants. Fortunately, pseudoephedrine and phenylephrine are typically not included in nighttime cough and cold formulations.

NyQuil syrup does contain high fructose corn syrup. So it may raise blood sugar levels. If you're considering using NyQuil, I would recommend using NyQuil Liquicaps, which would not have the same effect on your blood sugar.

It's important to note that when treating a cold, pharmacists and health care providers match a person's symptoms to the appropriate active ingredients. It may be possible that a multi-symptom product, such as NyQuil, contains more active ingredients than you need to treat your symptoms. Talk with your pharmacist who can help you select the best cough and cold product for your symptoms.

Question:

I am a 59-year-old woman with type 2 diabetes. Although I did not have a heart attack, I did have heart bypass surgery for five blockages nine years ago. My doctor has added Actos to my diabetic prescriptions, and I'm concerned about taking it. I read that this drug can cause heart-related problems and heart attacks, like the Avandia. Should I refuse this medication?

Answer:

This is an excellent question. It is true that there have been concerns with Avandia and cardiovascular events, such as heart attack and stroke. This medication should no longer be used and is restricted to a very specific subset of patients. Actos is part of the same class of medications as Avandia. However, the same cardiovascular risks have not been seen with Actos.

The Food and Drug Administration (FDA) is reviewing Actos to see if usage for one year or more can be associated with an increased risk of bladder cancer. If you are concerned about taking Actos, please discuss this with your health care provider. There are other options to adequately manage your diabetes that do not include taking Actos. You should always feel comfortable talking with your health care provider about your medication choices and should only use medications you feel comfortable with.

Question:

My mother has diabetes. She currently has allergies and a runny nose. What can she take?

Answer:

Allergy symptoms, such as a runny nose, are best treated with an antihistamine like chlorpheniramine (Chlor-Trimeton). Antihistamines are safe for people with diabetes to use. I would not recommend any products that contain pseudoephedrine or phenylephrine such as Sudafed or Sudafed PE. These medications may increase blood pressure, which can be a concern for someone with diabetes. Using pseudoephedrine or phenylephrine for only a couple of days may not be a problem. But avoiding them all together is the safest route.

Question:

Due to a cough that I've had for over 12 hours, I cannot rest or relax or sleep. I was prescribed promethazine with codeine syrup (cough suppressant). Will Lotrel interact with promethazine? I can't take NyQuil because of my diabetes

Answer:

Lotrel is a prescription medication for blood pressure. It does not interact with promethazine and codeine. Taking these medications may affect your blood pressure and heart rate. You may notice some lightheadedness or dizziness while taking the cough medicine. It would be a good idea to continue checking your blood pressure while you are sick. The cough medicine can also be very sedating, which will help you get some rest and feel better sooner. But it would be best to avoid driving while taking the cough medicine.

Question:

My dad took diabetes medication for six years. Now his doctor has taken him off of them. How long could his diabetes medications stay in his system?

Answer:

This is a difficult question to answer without knowing exactly which medications your dad was taking. Every medication has different ways of being metabolized, or broken down, in the body. Generally, it doesn’t take too long for medications to leave your system; maybe a few days to a week. I would recommend talking with your dad's pharmacist who can look at the entire list of his medications to give you a more exact answer.

Question:

Is smokeless tobacco a safer alternative for diabetics than smoking cigarettes?

Answer:

Smokeless tobacco is not a harmless form of tobacco and it is not a safe alternative to smoking cigarettes. The two main types of smokeless tobacco are chewing tobacco and snuff. Smokeless tobacco can cause cancer and oral health problems.

Electronic cigarettes are devices that mimic tobacco smoke and are marketed as an alternative to smoking. Using an electronic cigarette is better than smoking real cigarettes, although not quite as good as completely quitting and dropping your smoking habit altogether. There is concern that electronic cigarettes are appealing to non-smokers, like children. If you are interested in quitting smoking, talk with your pharmacist, as there are a number of options that can help you quit.

Question:

My husband is taking metformin for his diabetes and amlodipine for high blood pressure. He has a really bad cold with lots of mucus. What over-the-counter cold medications can he take?

Answer:

When treating a cold, pharmacists and health care providers consider the symptoms that an individual has and try to match those symptoms with the right active ingredients. Then we have to make sure that the active ingredients are safe to use with any pre-existing medical conditions, such as diabetes.

One of the best ways to relieve mucus congestion from a cold is to drink plenty of water. Drinking lots of water can help to break up phlegm and is, of course, completely safe for someone with diabetes. There is an active ingredient in some cough and cold products called guaifenesin. For diabetics, such cough and cold products are another safe choice for relieving chest congestion.

For nasal congestion, I would suggest a saline nasal spray. Completely safe for someone with diabetes, saline sprays can be just as effective as pseudoephedrine or phenylephrine. It's important for people with diabetes to talk with their pharmacists or health care providers before taking cough and cold medications.

I would not recommend that your husband use any products that contain pseudoephedrine or phenylephrine, such as Sudafed or Sudafed PE. These medications can increase blood pressure, which can be a concern for people with diabetes. Using pseudoephedrine or phenylephrine for a couple of days may not be a problem. But avoiding them altogether is the safest route.

Question:

For his diabetes my husband takes Januvia 100 mg, metformin 850 mg (one tablet twice a day), and uses a Victoza pen injection. He takes losartan 25 mg daily for his blood pressure and Advicor 500 mg/20 mg (two tablets twice a day) for cholesterol. He also takes vitamin D 2,000 IU and an aspirin. He comes home with pain in his legs and is exhausted at the end of his work day. Could any of these medications cause the side effects he is experiencing?

Answer:

When you are concerned about a problem someone is having, it is a good idea find out if the problem could be related to any medications the person is taking. Symptoms like leg pains and exhaustion can be hard to relate back to any one thing. Certainly, exercise or a strenuous work day could cause some muscle pain and a feeling of tiredness. But assuming that these symptoms are not the result of a hard day's work, it is good to consider medications.

Advicor is a prescription medication for cholesterol that contains niacin and lovastatin. Lovastatin has been linked to muscle pain when taken by itself and when taken with Januvia. To find out if these medications are the cause, it would be important to consider the time frame of when your husband started taking them and when he began experiencing muscle weakness and fatigue.

Although it's possible that what your husband is experiencing is the result of certain medications, it's just as possible that it is not. I would bring this concern to the attention of his health care provider. His doctor may consider adjusting his medications to see if the pain and exhaustion decreases. His doctor may also check his blood work to see if the exhaustion could be due to any other factors, such as anemia or thyroid disease.

Leg pain could be the result of muscle cramps from low potassium levels, or nerve pain related to long-term diabetes. As there are a number of things that these symptoms could be caused by, I think it's reasonable for your husband to get checked out by his doctor.

Question:

Is metformin used for anything other than treating of diabetes?

Answer:

Metformin is a commonly used medication for diabetes. In addition to helping manage type 2 diabetes, it may be used to treat gestational diabetes, or diabetes that arises during pregnancy. It has also been used to treat polycystic ovarian syndrome (PCOS), a condition in which a woman’s hormones are out of balance.

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