Interaction between converting enzyme inhibitors and solfonureas or insulin - Excluding tuberculous pleursy

Possible interactions: Converting enzyme inhibitors (CEI) can intensify the glucose lowering effect of insulin or sulfonureas. This interaction has be en observed in a few clinical cases and studied systematically in regional pharmacovigilance centers. Low risk rate: This interaction occurs in certain patients with well-contro lled 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 consi dered as negligible compared with the benefit of this class of well-tolerat ed 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 mar keted for a longer period. Captopril may have a stronger hypoglycemia effec t than enalapril. it has been demonstrated with hyperinsulin euglycemic cla mp that captopril improves sensitivity to insulin in healthy volunteers wit h normal blood pressure; with enalapril however, the increase in insulin se nsitivity is less pronounced and nonsignificant. An indirect mechanism: Captopril, and to a lesser extent enalapril, indirec tly increases insulin sensitivity by increasing circulating kinine which le ads to vasodilatation in the muscles and increased glucose uptake in muscle tissue.