Review
Copyright ©The Author(s) 2024.
World J Diabetes. May 15, 2024; 15(5): 853-866
Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.853
Table 1 Interactions between anti-tuberculosis drugs with anti- diabetes mellitus drugs
Anti-DM drug
Anti-TB drug
Interaction effects
Expected clinical effects
Biguanides
MetforminRifampin (RIF, INN, rifampicin) RIF induces upregulation of metformin effectsPromotes glucose-lowering effect of metformin[98]
Sulfonylurea group
TolbutamideRifampin (INN, rifampicin)RIF promotes the CYP2C9 and reduces in tolbutamide plasma concHyperglycemia and diminished anti-TB efficacy over time[18,84]
Glyburide (INN, glibenclamide)Rifampin (INN, rifampicin)RIF promotes the CYP2C9 and reduces 39% glyburide concHyperglycemia and diminished anti-TB efficacy over time[134]
Glyburide (INN, glibenclamide)RifapentineRifapentine induces CYP3A4 and CYP2C8/9 expressions and reduces glyburide plasma concHyperglycemia[81,135]
Glyburide (INN, glibenclamide)Bedaquiline Glyburide inhibits CYP3A4 in liver[85,136]
Glyburide (INN, glibenclamide)Delamanid Glyburide inhibits CYP3A4 in liver[85,136]
GliclazideRifampin (INN, rifampicin)RIF decreases plasma conc. of gliclazide by 70% by inducing CYP2C9Hyperglycemia and diminished anti-TB efficacy over time[18,137]
GliclazideRifapentineRifapentine induces CYP3A4 and CYP2C8/9 and decreases gliclazideHyperglycemia[81]
GliclazideBedaquiline M2 of bedaquiline inhibits effects on CYP3A4 and CYP2C8Hypoglycemic episodes[85]
GliclazideDelamanid No crossing interaction [85]
GlimepirideRifampin (INN, rifampicin)RIF promotes the expression of CYP2C9 reducing in 34% of glimepiride concHyperglycemia and diminished anti-TB efficacy over time[138]
GlipizideRifampin (INN, rifampicin)RIF promotes CYP2C9 and reduces 22% of glipizide concHyperglycemia and diminished anti-TB efficacy over time[134]
GliquidoneRifapentineRifapentine induces CYP3A4 and CYP2C8/9 and decreases gliquidoneHyperglycemia[81]
GliquidoneBedaquiline M2 of bedaquiline inhibits CYP3A4 effectsHypoglycemic episodes[85]
GliquidoneDelamanid Delamanid induces CYP3A4 and decreases gliquidone level[85]
Meglitinide analogues
RepaglinideRifampin (INN, rifampicin) RIF promotes CYP3A4 and reduces repaglinide conc. 57%Hyperglycemia and diminished anti-TB efficacy over time[18,138-140]
RepaglinideRifapentineRifapentine induces CYP3A4 and CYP2C8 and decreases repaglinide levelHyperglycemia[81]
RepaglinideBedaquiline Interindividual variabilityVariable hypoglycemic episodes[85,141]
RepaglinideDelamanid Interindividual variabilityVariable hypoglycemic episodes[85,141]
NateglinideRifampin (INN, rifampicin)RIF promotes CYP3A4 and CYP2C9 and reduces nateglinide conc by 24%.Hyperglycemia and diminished anti-TB efficacy over time[84]
NateglinideRifapentineRifapentine induces CYP3A4 and CYP2C9 and decreases nateglinide levelHyperglycemia[81]
NateglinideBedaquilineM2 of bedaquiline inhibits effects on CYP3A4 Hypoglycemic episodes[85]
NateglinideDelamanidCoadministration of delamanid with nateglinide reduces exposure to delamanidTB reactivation[85,142]
Thiazolidinediones
RosiglitazoneRifampin (INN, rifampicin)RIF promotes CYP2C8 and reduces of rosiglitazone conc by 65%Hyperglycemia and diminished anti-TB efficacy over time[18,92]
RosiglitazoneRifapentineRifapentine induces CYP3A4 and CYP2C9 and decreases rosiglitazone levelHyperglycemia[81]
RosiglitazoneBedaquiline M2 of bedaquiline inhibits effects on CYP2A8Hypoglycemic episodes[85]
Rosiglitazone Delamanid No crossing[116]
PioglitazoneRifampin (INN, rifampicin)RIF promotes CYP2C8 and reduces pioglitazone conc by 65%Hyperglycemia and diminished anti-TB efficacy over time[20,62,143]
PioglitazoneRifapentine Rifapentine induces CYP3A4 and CYP2C8 and decreases pioglitazone levelHyperglycemia[81]
Pioglitazone Bedaquiline In combination with bedaquiline, pioglitazone may cause severe acute rhabdomyolysisDose-independent myalgia[85,144]
Pioglitazone Delamanid Inhibitory effects on CYP3A4Hypoglycemic episodes[85]
Dipeptidyl peptidase IV inhibitors
SitagliptinRifapentineRifapentine induces CYP3A4 and CYP2C8 and decreases sitagliptin levelHyperglycemia[81]
Sitagliptin Bedaquiline M2 of bedaquiline inhibits effects on CYP3A4 and CYP2A8Hypoglycemic episodes[85]
Sitagliptin Delamanid Inhibitory effects on CYP3A4Hypoglycemic episodes[85]
SaxagliptinRifapentineRifapentine induces CYP3A4 and decreases saxagliptin levelHyperglycemia[81]
SaxagliptinBedaquiline M2 of bedaquiline inhibits effects on CYP3A4 Hypoglycemic episodes[85]
Saxagliptin Delamanid Inhibitory effects on CYP3A4Hypoglycemic episodes[85]
InsulinNo effect anticipatedNo studies published[85]
IsoniazidIn DM patientsIsoniazid in combination with rifampicin causes hepatotoxicity TB-DM patients (50%)Low Anti-TB efficacy[34,84,128,129]
IsoniazidHIV-positive patient with type 2 DMProphylaxis of TBHyperglycaemia induced by isoniazid[20,145]
PyrazinamideIn DM patientsDM patients with higher levels of xanthine oxidase causes low therapeutic targets for pyrazinamideTB resistance[20,86,88]
EthambutolIn DM patientsNeuritis optica in patients with complicated diabetes. Reduced kidney function in TB-DM patientsEnhances side effects[20,89]