prednisolone and metformin

ModerateUsually manageable, but it must be recognised and monitored.

Mechanism

Prednisolone increases hepatic gluconeogenesis and reduces peripheral insulin sensitivity, which directly opposes the antihyperglycaemic action of metformin. This pharmacodynamic antagonism leads to reduced effectiveness of metformin in controlling blood glucose.

What it means clinically

In patients with diabetes, co-administration of prednisolone and metformin can cause elevated blood glucose concentrations, resulting in worsening glycaemic control. This may necessitate intensification of antidiabetic therapy and increase the risk of hyperglycaemic complications.

What to do

Monitor blood glucose regularly when prednisolone is started, stopped, or the dose is changed. Consider adjusting the metformin dose, adding other antihyperglycaemic agents, or using a non-steroidal alternative if appropriate for the underlying condition.

Evidence

Well-established interaction documented in drug prescribing information and clinical guidelines. The hyperglycaemic effect of corticosteroids is consistently reported in clinical studies.

The two drugs

prednisoloneCorticosteroidsRead the monograph metforminBiguanideRead the monograph

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Other interactions involving prednisolone or metformin

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.