Please wait while the formulary information is being retrieved.
Drug overview for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
Generic name: insulin degludec/liraglutide (IN-su-lin de-GLOO-dek/LIR-a-GLOO-tide)
Drug class: Intermediate-, Long-acting, and Combination Insulins
Therapeutic class: Endocrine
Insulin degludec is a biosynthetic (rDNA origin), long-acting basal human Liraglutide, a synthetic, long-acting human glucagon-like peptide-1 (GLP-1) insulin analog. receptor agonist (incretin mimetic), is an antidiabetic agent and antiobesity drug.
Liraglutide (Victoza(R)) is used as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus andalso is used to reduce the risk of major adverse cardiovascular events (i.e., cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke) in patients with type 2 diabetes mellitus and established cardiovascular disease. Liraglutide in fixed combination with insulin degludec (insulin degludec/liraglutide;Xultophy(R)) is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Liraglutide (Saxenda(R)) is used for chronic weight management.
Generic name: insulin degludec/liraglutide (IN-su-lin de-GLOO-dek/LIR-a-GLOO-tide)
Drug class: Intermediate-, Long-acting, and Combination Insulins
Therapeutic class: Endocrine
Insulin degludec is a biosynthetic (rDNA origin), long-acting basal human Liraglutide, a synthetic, long-acting human glucagon-like peptide-1 (GLP-1) insulin analog. receptor agonist (incretin mimetic), is an antidiabetic agent and antiobesity drug.
Liraglutide (Victoza(R)) is used as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus andalso is used to reduce the risk of major adverse cardiovascular events (i.e., cardiovascular death, nonfatal myocardial infarction (MI), nonfatal stroke) in patients with type 2 diabetes mellitus and established cardiovascular disease. Liraglutide in fixed combination with insulin degludec (insulin degludec/liraglutide;Xultophy(R)) is used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Liraglutide (Saxenda(R)) is used for chronic weight management.
DRUG IMAGES
XULTOPHY 100 UNIT-3.6MG/ML PEN
The following indications for XULTOPHY 100/3.6 (insulin degludec/liraglutide) have been approved by the FDA:
Indications:
Type 2 diabetes mellitus
Professional Synonyms:
Adult onset diabetes mellitus
Adult onset diabetes
Adult onset DM
Diabetes mellitus type 2
Diabetes mellitus type II
Ketosis-resistant diabetes mellitus
Ketosis-resistant DM
Maturity onset diabetes mellitus
Maturity onset diabetes
Non-insulin dependent diabetes mellitus
Non-insulin-dependent diabetes mellitus
Type II diabetes mellitus
Indications:
Type 2 diabetes mellitus
Professional Synonyms:
Adult onset diabetes mellitus
Adult onset diabetes
Adult onset DM
Diabetes mellitus type 2
Diabetes mellitus type II
Ketosis-resistant diabetes mellitus
Ketosis-resistant DM
Maturity onset diabetes mellitus
Maturity onset diabetes
Non-insulin dependent diabetes mellitus
Non-insulin-dependent diabetes mellitus
Type II diabetes mellitus
The following dosing information is available for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
No enhanced Dosing information available for this drug.
Insulin degludec is administered by subcutaneous injection once daily. Because of its delayed absorption and long duration of action, insulin degludec may be administered at any time of the day in adults. However, in pediatric patients, the drug should be administered once daily at the same time every day.
The fixed combination of insulin degludec and liraglutide (Xultophy(R)) is administered by subcutaneous injection once daily at the same time each day without regard to meals in adults; the injection is commercially available for administration in a prefilled, single-patient-use injection pen. The accompanying labeling should be consulted for proper methods of administration and care of the injection pen Insulin degludec or the fixed combination of insulin degludec and liraglutide should not be given IV or IM, nor should it be given via an insulin infusion pump. Insulin degludec or the fixed combination with liraglutide should not be mixed with any other insulin preparations or solutions.
Insulin degludec or the fixed combination of insulin degludec and liraglutide is administered subcutaneously into the thigh, abdomen, or upper arm. A planned rotation of sites within an area should be followed to reduce the risk of lipodystrophy and localized cutaneous amyloidosis; injections should not be placed into areas of existing lipodystrophy or localized cutaneous amyloidosis. Insulin degludec (Tresiba(R)) is commercially available for administration in the FlexTouch(R)prefilled, single-patient-use injection pen; the drug is also available in a multiple-dose vial.
The accompanying labeling should be consulted for proper methods of administration and care of the FlexTouch(R) pen or the multiple-dose vial. Insulin degludec should not be transferred from the FlexTouch(R) injection pen into a syringe for administration. Dose conversions between the insulin degludec 100- and 200-units/mL FlexTouch(R) injection pens based on the differences in insulin concentration are not necessary and should not be performed.
The dose window for the insulin degludec 100- and 200-units/mL FlexTouch(R) injection pens display the number of insulin degludec units to be delivered independent of insulin concentration, and no conversion is needed to calculate the dose using either injection pen. Insulin degludec may alternatively be administered by subcutaneous injection from the multiple-dose vial using a syringe and needle. For adults who miss a dose of insulin degludec, the missed dose should be administered as soon as remembered during waking hours if at least 8 hours have elapsed between consecutive doses.
If a pediatric patient misses a dose of insulin degludec, the patient or a parent or caregiver should be instructed to contact the child's clinician for guidance about dosing and monitoring blood glucose concentrations more frequently until the next scheduled insulin degludec dose. Patients who miss a dose of the fixed combination of insulin degludec and liraglutide should be instructed to resume the once-daily regimen as prescribed with the next scheduled dose; however, if more than 3 days have elapsed since the last dose, the fixed combination therapy should be re-initiated at the starting dose to mitigate GI symptoms related to the liraglutide component. Unopened injection pens and multiple dose vials containing insulin degludec should be stored at 2-8degreesC until the expiration date.
Alternatively, unopened insulin degludec injection pens and vials may be stored at room temperature (up to 30degreesC) for up to 56 days. Injection pens containing insulin degludec and vials containing insulin degludec should not be subjected to freezing; if freezing has occurred, the pen/vial should not be used. Vials containing insulin degludec should be stored in the original sealed carton to protect from light.
In-use insulin degludec pens and vials may be stored at room temperature (up to 30degreesC) or under refrigeration (2-8degreesC) away from direct heat and light for up to 56 days. Unopened injection pens containing the fixed combination of insulin degludec and liraglutide should be stored at 2-8degreesC until the expiration date. Injection pens containing the fixed combination preparation should not be subjected to freezing; if freezing has occurred, the pen should not be used.
In-use pens may be stored at room temperature (15-30degreesC) or under refrigeration (2-8degreesC) away from direct heat and light for up to 21 days. Liraglutide or the fixed combination of insulin degludec and liraglutide (insulin degludec/liraglutide) is administered by subcutaneous injection into the abdomen, thigh, or upper arm using a prefilled injection pen; the drug must not be administered IV or IM. Liraglutide is administered once daily at any time of day, without regard to meals.
The injection site and timing can be changed without dosage adjustment. Rotate injection sites within the same region to reduce the risk of cutaneous amyloidosis. The fixed combination of insulin degludec/liraglutide is administered by subcutaneous injection once daily at the same time each day without regard to meals.
If a dose of liraglutide orinsulin degludec/liraglutide is missed, the regular schedule should be resumed with the next scheduled dose; an extra dose or increase in dose should not be taken to replace a missed dose. If more than 3 days have elapsed since the last dose of liraglutide orinsulin degludec/liraglutide, the initial dosage should be restarted and retitrated. When using liraglutide in combination with insulin for the management of type 2 diabetes mellitus, the drugs should be administered as separate injections; insulin and liraglutide should never be mixed.
Liraglutide and insulin may be injected in the same body regions; however, the injections should not be adjacent to each other. Liraglutide in fixed combination with insulin degludec is commercially available as Xultophy(R). The fixed combination of insulin degludec and liraglutide should not be mixed with any other insulin preparations or solutions.
The fixed combination of insulin degludec and liraglutide (Xultophy(R)) is administered by subcutaneous injection once daily at the same time each day without regard to meals in adults; the injection is commercially available for administration in a prefilled, single-patient-use injection pen. The accompanying labeling should be consulted for proper methods of administration and care of the injection pen Insulin degludec or the fixed combination of insulin degludec and liraglutide should not be given IV or IM, nor should it be given via an insulin infusion pump. Insulin degludec or the fixed combination with liraglutide should not be mixed with any other insulin preparations or solutions.
Insulin degludec or the fixed combination of insulin degludec and liraglutide is administered subcutaneously into the thigh, abdomen, or upper arm. A planned rotation of sites within an area should be followed to reduce the risk of lipodystrophy and localized cutaneous amyloidosis; injections should not be placed into areas of existing lipodystrophy or localized cutaneous amyloidosis. Insulin degludec (Tresiba(R)) is commercially available for administration in the FlexTouch(R)prefilled, single-patient-use injection pen; the drug is also available in a multiple-dose vial.
The accompanying labeling should be consulted for proper methods of administration and care of the FlexTouch(R) pen or the multiple-dose vial. Insulin degludec should not be transferred from the FlexTouch(R) injection pen into a syringe for administration. Dose conversions between the insulin degludec 100- and 200-units/mL FlexTouch(R) injection pens based on the differences in insulin concentration are not necessary and should not be performed.
The dose window for the insulin degludec 100- and 200-units/mL FlexTouch(R) injection pens display the number of insulin degludec units to be delivered independent of insulin concentration, and no conversion is needed to calculate the dose using either injection pen. Insulin degludec may alternatively be administered by subcutaneous injection from the multiple-dose vial using a syringe and needle. For adults who miss a dose of insulin degludec, the missed dose should be administered as soon as remembered during waking hours if at least 8 hours have elapsed between consecutive doses.
If a pediatric patient misses a dose of insulin degludec, the patient or a parent or caregiver should be instructed to contact the child's clinician for guidance about dosing and monitoring blood glucose concentrations more frequently until the next scheduled insulin degludec dose. Patients who miss a dose of the fixed combination of insulin degludec and liraglutide should be instructed to resume the once-daily regimen as prescribed with the next scheduled dose; however, if more than 3 days have elapsed since the last dose, the fixed combination therapy should be re-initiated at the starting dose to mitigate GI symptoms related to the liraglutide component. Unopened injection pens and multiple dose vials containing insulin degludec should be stored at 2-8degreesC until the expiration date.
Alternatively, unopened insulin degludec injection pens and vials may be stored at room temperature (up to 30degreesC) for up to 56 days. Injection pens containing insulin degludec and vials containing insulin degludec should not be subjected to freezing; if freezing has occurred, the pen/vial should not be used. Vials containing insulin degludec should be stored in the original sealed carton to protect from light.
In-use insulin degludec pens and vials may be stored at room temperature (up to 30degreesC) or under refrigeration (2-8degreesC) away from direct heat and light for up to 56 days. Unopened injection pens containing the fixed combination of insulin degludec and liraglutide should be stored at 2-8degreesC until the expiration date. Injection pens containing the fixed combination preparation should not be subjected to freezing; if freezing has occurred, the pen should not be used.
In-use pens may be stored at room temperature (15-30degreesC) or under refrigeration (2-8degreesC) away from direct heat and light for up to 21 days. Liraglutide or the fixed combination of insulin degludec and liraglutide (insulin degludec/liraglutide) is administered by subcutaneous injection into the abdomen, thigh, or upper arm using a prefilled injection pen; the drug must not be administered IV or IM. Liraglutide is administered once daily at any time of day, without regard to meals.
The injection site and timing can be changed without dosage adjustment. Rotate injection sites within the same region to reduce the risk of cutaneous amyloidosis. The fixed combination of insulin degludec/liraglutide is administered by subcutaneous injection once daily at the same time each day without regard to meals.
If a dose of liraglutide orinsulin degludec/liraglutide is missed, the regular schedule should be resumed with the next scheduled dose; an extra dose or increase in dose should not be taken to replace a missed dose. If more than 3 days have elapsed since the last dose of liraglutide orinsulin degludec/liraglutide, the initial dosage should be restarted and retitrated. When using liraglutide in combination with insulin for the management of type 2 diabetes mellitus, the drugs should be administered as separate injections; insulin and liraglutide should never be mixed.
Liraglutide and insulin may be injected in the same body regions; however, the injections should not be adjacent to each other. Liraglutide in fixed combination with insulin degludec is commercially available as Xultophy(R). The fixed combination of insulin degludec and liraglutide should not be mixed with any other insulin preparations or solutions.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
There are 0 contraindications.
There are 1 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Antidiabetic Agents/Gatifloxacin SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. CLINICAL EFFECTS: Concurrent use of gatifloxacin may result in hypoglycemia and/or hyperglycemia.(1-4) Hypoglycemia is more common during the first three days of concurrent therapy. Hyperglycemia is more common after the first three days of concurrent therapy.(2) PREDISPOSING FACTORS: Elderly patients, especially those with decreased renal function may be predisposed to this interaction.(2) PATIENT MANAGEMENT: Patients receiving concurrent gatifloxacin should be closely monitored for hypoglycemia during the first three days of concurrent therapy and for hyperglycemia after the first three days of concurrent therapy. Patients should be instructed to discontinue gatifloxacin if hypoglycemia or hyperglycemia occur.(2) DISCUSSION: Hypoglycemia has been reported with gatifloxacin and glyburide(1,5,6) or glimepiride.(7) In a study in patients with type 2 diabetes mellitus, concurrent gatifloxacin (400 mg daily for 10 days) had no effect on the pharmacokinetics of glyburide (steady state daily regimen); however, pharmacodynamic interactions have been reported.(2) Health Canada has received 19 reports of hypoglycemia in patients taking gatifloxacin. Seventeen of these involved concurrent hypoglycemic agents. Health Canada has received 2 reports of hyperglycemia in patients taking gatifloxacin and hypoglycemic agents. Health Canada has received 2 reports of patients experiencing hypoglycemia and hyperglycemia during concurrent gatifloxacin and hypoglycemic agents.(3) In a study, 13 reports of dysglycemia were reported in patients taking gatifloxacin. Ten of these patients had diabetes mellitus and were on concurrent hypoglycemic agents. Of these ten patients, nine patients experienced hypoglycemia, while one patient experienced hyperglycemia.(8) |
GATIFLOXACIN SESQUIHYDRATE |
There are 13 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Antidiabetics/Epinephrine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Gluconeogenesis, glycogenolysis, and lipolysis are increased by epinephrine. Also, insulin secretion and glucose uptake by peripheral tissues are decreased by epinephrine. CLINICAL EFFECTS: Increased blood glucose resulting in decreased effectiveness of the antidiabetic agent. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Caution when starting or stopping epinephrine in diabetic patients. Adjust the antidiabetic dose as needed based on blood glucose levels. DISCUSSION: This interaction is likely to occur based upon well documented properties of the interacting drugs. However, there is individual variability in its occurrence. |
ADRENALIN, ARTICADENT DENTAL, ARTICAINE-EPINEPHRINE, ARTICAINE-EPINEPHRINE BIT, BUFFERED LIDOCAINE-EPINEPHRINE, BUPIVACAINE HCL-EPINEPHRINE, BUPIVACAINE-DEXAMETH-EPINEPHRN, CITANEST FORTE DENTAL, EPINEPHRINE, EPINEPHRINE BITARTRATE, EPINEPHRINE HCL-0.9% NACL, EPINEPHRINE HCL-D5W, EPINEPHRINE-0.9% NACL, EPINEPHRINE-D5W, LIDOCAINE HCL-EPINEPHRINE, LIDOCAINE HCL-EPINEPHRINE-NACL, LIDOCAINE-EPINEPHRINE, LIGNOSPAN STANDARD, MARCAINE-EPINEPHRINE, ORABLOC, R.E.C.K.(ROPIV-EPI-CLON-KETOR), RACEPINEPHRINE HCL, SENSORCAINE-EPINEPHRINE, SENSORCAINE-MPF EPINEPHRINE, SEPTOCAINE, VIVACAINE, XYLOCAINE DENTAL-EPINEPHRINE, XYLOCAINE WITH EPINEPHRINE, XYLOCAINE-MPF WITH EPINEPHRINE |
| Selected Antidiabetics/MAOIs SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism by which MAO inhibitors affect carbohydrate metabolism and subsequent enhancement of the hypoglycemic action of insulin is not clear. The adrenergic response to hypoglycemia may be blocked by insulin release caused by MAOI's. In vitro studies have shown that MAO inhibitors are capable of both potentiating and inhibiting insulin release, depending on their concentrations. Stimulation of glucose-mediated insulin secretion is believed to be related to the MAO inhibitory effects of the drugs. CLINICAL EFFECTS: The hypoglycemic response to both insulin and glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylurea may be increased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Concurrent MAO inhibitor therapy for depression in a diabetic patient will often require reduction in dosage of the hypoglycemic agent because of enhanced hypoglycemic effects. Since the extent of the reaction is highly unpredictable, any diabetic patients receiving MAO inhibitors should be monitored for possible excessive hypoglycemia. DISCUSSION: This interaction is likely to occur. The interaction between MAOIs and insulin is well documented. Additional documentation is necessary to confirm the potential interaction of MAOI's with other glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylureas but is expected to occur based on pharmacologic similarity. It may take several weeks for the full hypoglycemic effect of the MAOI to occur. Conversely, it may take several weeks for the effect to dissipate after stopping the MAOI. Furazolidone is known to be a monoamine oxidase inhibitor. Methylene blue, when administered intravenously, has been shown to reach sufficient concentrations to be a potent inhibitor of MAO-A. Metaxalone is a weak inhibitor of MAO. |
AZILECT, EMSAM, FURAZOLIDONE, LINEZOLID, LINEZOLID-0.9% NACL, LINEZOLID-D5W, MARPLAN, MATULANE, METAXALONE, METHYLENE BLUE, NARDIL, PARNATE, PHENELZINE SULFATE, PROCARBAZINE HCL, PROVAYBLUE, RASAGILINE MESYLATE, SELEGILINE HCL, TRANYLCYPROMINE SULFATE, ZELAPAR, ZYVOX |
| Thiazides/Antidiabetics SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Thiazides antagonize hypoglycemic effects of antidiabetics due to intrinsic hyperglycemic activity. CLINICAL EFFECTS: Impaired glucose tolerance and diminished hypoglycemic effects of antidiabetics may occur. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Caution when starting or stopping thiazides in diabetic patients. Adjust the antidiabetic dose as needed based on blood glucose levels. DISCUSSION: This interaction is likely to occur based upon well documented properties of the interacting drugs. However, there is individual variability in its occurrence. A cross-sectional study of 425 outpatients found 46 patients with 86 suspected drug interactions resulting in uncontrolled glycemia. Recorded drug interactions included hydrochlorothiazide-gliclazide (22.1%), hydrochlorothiazide-insulins (2.3%), and chlorothiazide-gliclazide (1.2%). Using the drug interaction probability scale (DIPS), these drug interactions were categorized as possible.(2) |
AMILORIDE-HYDROCHLOROTHIAZIDE, AMLODIPINE-VALSARTAN-HCTZ, ATACAND HCT, ATENOLOL-CHLORTHALIDONE, AVALIDE, BENAZEPRIL-HYDROCHLOROTHIAZIDE, BENICAR HCT, BISOPROLOL-HYDROCHLOROTHIAZIDE, CANDESARTAN-HYDROCHLOROTHIAZID, CAPTOPRIL-HYDROCHLOROTHIAZIDE, CHLOROTHIAZIDE, CHLOROTHIAZIDE SODIUM, CHLORTHALIDONE, DIOVAN HCT, DIURIL, EDARBYCLOR, ENALAPRIL-HYDROCHLOROTHIAZIDE, EXFORGE HCT, FOSINOPRIL-HYDROCHLOROTHIAZIDE, HEMICLOR, HYDROCHLOROTHIAZIDE, HYZAAR, INDAPAMIDE, INZIRQO, IRBESARTAN-HYDROCHLOROTHIAZIDE, LISINOPRIL-HYDROCHLOROTHIAZIDE, LOSARTAN-HYDROCHLOROTHIAZIDE, LOTENSIN HCT, METHYLDOPA-HYDROCHLOROTHIAZIDE, METOLAZONE, METOPROLOL-HYDROCHLOROTHIAZIDE, MICARDIS HCT, OLMESARTAN-AMLODIPINE-HCTZ, OLMESARTAN-HYDROCHLOROTHIAZIDE, PROPRANOLOL-HYDROCHLOROTHIAZID, QUINAPRIL-HYDROCHLOROTHIAZIDE, SPIRONOLACTONE-HCTZ, TELMISARTAN-HYDROCHLOROTHIAZID, TENORETIC 100, TENORETIC 50, THALITONE, TRIAMTERENE-HYDROCHLOROTHIAZID, TRIBENZOR, TRICHLORMETHIAZIDE, VALSARTAN-HYDROCHLOROTHIAZIDE, VASERETIC, ZESTORETIC |
| Insulin/Fenfluramine;Dexfenfluramine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Fenfluramine increases glucose uptake at the receptor site (ie, skeletal muscle). CLINICAL EFFECTS: The hypoglycemic effect of insulin is increased. PREDISPOSING FACTORS: Diabetes. PATIENT MANAGEMENT: In diabetic patients receiving insulin, monitor blood glucose levels and observe the patient for signs of hypoglycemia when initiating therapy with fenfluramine and for symptoms of hyperglycemia when fenfluramine is discontinued. DISCUSSION: When administered before meals or to fasting patients, fenfluramine has been found to have hypoglycemic action. Numerous reports have demonstrated fenfluramine to potentiate the hypoglycemic effect of insulin in diabetic patients. |
FINTEPLA |
| Pioglitazone/Insulin SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown, but may be the result of additive fluid retention.(1,2) CLINICAL EFFECTS: The concurrent use of pioglitazone with insulin may increase the risk of edema and heart failure.(1,2) PREDISPOSING FACTORS: Specific risk factors for heart failure could not be determined. Patients with ongoing edema are more likely to have edema-associated adverse effects with combination therapy.(1) PATIENT MANAGEMENT: Patients receiving concurrent therapy should be monitored for cardiovascular adverse events. If signs and symptoms of congestive heart failure develop, patients should be treated according to current standards of care. Consideration should be given to lowering the dosage of or discontinuing pioglitazone.(1,2) DISCUSSION: In a clinical trial, two of 191 (1.1%) of patients receiving pioglitazone (15 mg) and insulin and two of 188 (1.1%) of patients receiving pioglitazone (30 mg) and insulin developed congestive heart failure. None of the patients receiving insulin alone developed congestive heart failure.(1) |
ACTOPLUS MET, ACTOS, ALOGLIPTIN-PIOGLITAZONE, DUETACT, OSENI, PIOGLITAZONE HCL, PIOGLITAZONE-GLIMEPIRIDE, PIOGLITAZONE-METFORMIN |
| Bupropion/Hypoglycemics; Insulin SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Bupropion can lower the seizure threshold and when given concurrently with other medications that also lower the threshold there is an increased risk of seizure.(1,2) CLINICAL EFFECTS: Concurrent use of bupropion and hypoglycemics or insulin may increase the risk of seizure.(1,2) PREDISPOSING FACTORS: The risk of seizures may be increased in patients with a history of head trauma or prior seizure; CNS tumor; severe hepatic cirrhosis; excessive use of alcohol or sedatives; addiction to opiates, cocaine, or stimulants; use of over-the-counter stimulants an anorectics; a total daily dose of bupropion greater than 450 mg or single doses greater than 150 mg; rapid escalation of bupropion dosage; or with concomitant medications known to lower seizure threshold (antidepressants, antipsychotics, systemic steroids, theophylline).(1,2) PATIENT MANAGEMENT: The use of bupropion in patients treated with oral hypoglycemic agents or insulin should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1,2) Single doses should not exceed 150 mg.(1,2) The maximum daily dose of bupropion should not exceed 300 mg for smoking cessation(2) or 450 mg for depression.(1) DISCUSSION: Because of the risk of seizure from concurrent bupropion and other agents that lower seizure threshold, the manufacturer of bupropion states that the concurrent use of bupropion and oral hypoglycemic agents or insulin should be undertaken only with extreme caution and with low initial bupropion dosing and small gradual dosage increases.(1,2) |
APLENZIN, AUVELITY, BUPROPION HCL, BUPROPION HCL SR, BUPROPION XL, CONTRAVE, WELLBUTRIN SR, WELLBUTRIN XL |
| Selected Antidiabetic Agents/Selected Quinolones SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown. CLINICAL EFFECTS: Concurrent use of quinolones and antidiabetic agents may result in severe hypoglycemia.(1-7) Hypoglycemia can lead to coma. PREDISPOSING FACTORS: Elderly patients, especially those with decreased renal function may be predisposed to this interaction.(5) PATIENT MANAGEMENT: Patients maintained on antidiabetic agents who require concurrent therapy with a quinolone should be closely monitored for hypoglycemia.(1-4) Patients should be instructed to discontinue quinolone use and contact their doctor if hypoglycemia occurs.(2,4) Signs of hypoglycemia may include confusion, dizziness, feeling shaky, unusual hunger, headaches, irritability, pounding heart or very fast pulse, pale skin, sweating, trembling, weakness, or unusual anxiety. DISCUSSION: Hypoglycemia has been reported with concurrent ciprofloxacin and glyburide,(1,8,9) levofloxacin and glyburide,(2,10,11) norfloxacin and glyburide,(3) levofloxacin and glipizide (12) as well as levofloxacin and metformin-glibenclamide.(14) There has been one report of fatal hypoglycemia with concurrent levofloxacin and glyburide(9) and one of the above reports of hypoglycemia with concurrent levofloxacin and glyburide resulted in hypoxic brain injury.(11) A review of postmarketing adverse event data for the fluoroquinolones and hypoglycemic coma identified 56 reports in FAERS search from October 1987- April 2017 and 11 additional cases in the medical literature. Most patients had risk factors for hypoglycemia. 41 patients were taking one or more hypoglycemic drugs. 13 deaths occurred (some of these patients had renal insufficiency). 9 patients did not fully recover and had resultant disability.(13) |
AVELOX IV, BAXDELA, CIPRO, CIPROFLOXACIN, CIPROFLOXACIN HCL, CIPROFLOXACIN-D5W, LEVOFLOXACIN, LEVOFLOXACIN HEMIHYDRATE, LEVOFLOXACIN-D5W, MOXIFLOXACIN, MOXIFLOXACIN HCL, OFLOXACIN |
| Antidiabetics/Selected Ophthalmic Non-Cardioselective Beta-Blockers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Not fully established. Probably blockade of a variety of beta-adrenergic responses to hypoglycemia.(1,2) CLINICAL EFFECTS: Diminished response to sulfonylureas and insulin may occur. Frequency and severity of hypoglycemic episodes may be increased, while warning symptoms of low blood sugar may be masked.(1,2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Try to avoid beta-blocker therapy, particularly in diabetics prone to hypoglycemic attacks. One of the cardioselective agents may decrease risk of hypertensive attacks and allow more rapid glucose recovery from hypoglycemia. Patients should be counseled not to rely on tachycardia to diagnose hypoglycemia, since it is masked by beta-blocker therapy. Diaphoresis is unaffected by beta-blockade and can be used by the diabetic to recognize hypoglycemia. DISCUSSION: A double blind, randomized, 12 month study of 39 patients tested the metabolic effects of pindolol (5mg BID) compared to control group on insulin sensitivity. The patient's insulin sensitivity index decreased 17% when on pindolol treatment compared to placebo (p<0.01). Insulin mediated glucose uptake was significantly lower (p<0.05) with propranolol treatment than with placebo.(3) A study of 26 patients with chronic heart failure showed that carvedilol (average daily dose 27.5mg/d) caused a significant decrease in fasting insulin levels (17.09 to 10.77 microU/ml, p <0.05) compared to pre-treatment levels. This trial also showed that patients on carvedilol had significantly (p=0.015) lower fasting insulin levels (10.77 microU/ml) compared to the fasting insulin levels (20.72 microU/ml) of patients on bisoprolol treatment (5.9mg/d).(4) There have been case reports of hypoglycemia following the addition of ophthalmic timolol to a diabetic regimen.(5-7) Studies have shown that ophthalmic beta-blockers, especially the aqueous solution, have significant systemic absorption and do not undergo first-pass metabolism.(8,9) |
BETIMOL, BIMATOPROST-DORZOLAMID-TIMOLOL, BRIMONIDINE TARTRATE-TIMOLOL, CARTEOLOL HCL, COMBIGAN, COSOPT, COSOPT PF, DORZOLAMIDE-TIMOLOL, ISTALOL, LEVOBUNOLOL HCL, TIMOLOL, TIMOLOL MALEATE, TIMOLOL-BIMATOPROST, TIMOLOL-BRIMONI-DORZOL-BIMATOP, TIMOLOL-BRIMONIDIN-DORZOLAMIDE, TIMOLOL-DORZOLAMIDE-BIMATOPRST, TIMOPTIC OCUDOSE |
| Insulin/Selected Systemic Non-Cardioselective Beta-Blockers SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Not fully established. Probably blockade of a variety of beta-adrenergic responses to hypoglycemia. CLINICAL EFFECTS: Diminished response to insulin may occur. Frequency and severity of hypoglycemic episodes may be increased, while warning symptoms of low blood sugar may be masked. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Try to avoid beta-blocker therapy, particularly in diabetics prone to hypoglycemic attacks. One of the cardioselective agents may decrease risk of hypertensive attacks and allow more rapid glucose recovery from hypoglycemia. Patients should be counseled not to rely on tachycardia to diagnose hypoglycemia, since it is masked by beta-blocker therapy. Diaphoresis is unaffected by beta-blockade and can be used by the diabetic to recognize hypoglycemia. DISCUSSION: A class effect of diminished glucose-lowering effects is expected with concurrent use of beta-blockers and insulin. It is prudent to monitor serum glucose closely in patients receiving beta-blocker therapy because symptoms of hypoglycemia may be masked. A double blind, randomized, 12 month study of 39 patients tested the metabolic effects of pindolol (5 mg BID) compared to control group on insulin sensitivity. The patient's insulin sensitivity index decreased 17% when on pindolol treatment compared to placebo (p<0.01). Insulin mediated glucose uptake was significantly lower (p<0.05) with propranolol treatment than with placebo. (1) A study of 26 patients with chronic heart failure showed that carvedilol (average daily dose 27.5 mg/d) caused a significant decrease in fasting insulin levels (17.09 to 10.77 microU/ml, p <0.05) compared to pre-treatment levels. This trial also showed that patients on carvedilol had significantly (p=0.015) lower fasting insulin levels (10.77 microU/ml) compared to the fasting insulin levels (20.72 microU/ml) of patients on bisoprolol treatment (5.9mg/d).(2) |
BETAPACE, BETAPACE AF, HEMANGEOL, INDERAL LA, INDERAL XL, INNOPRAN XL, NADOLOL, PINDOLOL, PROPRANOLOL HCL, PROPRANOLOL HCL ER, PROPRANOLOL-HYDROCHLOROTHIAZID, SOTALOL, SOTALOL AF, SOTALOL HCL, SOTYLIZE, TIMOLOL MALEATE |
| Insulin/Carvedilol; Labetalol SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Not fully established. Probably blockade of a variety of beta-adrenergic responses to hypoglycemia. CLINICAL EFFECTS: Diminished response to insulin may occur. Frequency and severity of hypoglycemic episodes may be increased, while warning symptoms of low blood sugar may be masked. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Try to avoid beta-blocker therapy, particularly in diabetics prone to hypoglycemic attacks. One of the cardioselective agents may decrease risk of hypertensive attacks and allow more rapid glucose recovery from hypoglycemia. Patients should be counseled not to rely on tachycardia to diagnose hypoglycemia, since it is masked by beta-blocker therapy. Diaphoresis is unaffected by beta-blockade and can be used by the diabetic to recognize hypoglycemia. DISCUSSION: A class effect of diminished glucose-lowering effects is expected with concurrent use of beta-blockers and insulin. It is prudent to monitor serum glucose closely in patients receiving beta-blocker therapy because symptoms of hypoglycemia may be masked. A double blind, randomized, 12 month study of 39 patients tested the metabolic effects of pindolol (5 mg BID) compared to control group on insulin sensitivity. The patient's insulin sensitivity index decreased 17% when on pindolol treatment compared to placebo (p<0.01). Insulin mediated glucose uptake was significantly lower (p<0.05) with propranolol treatment than with placebo. (1) A study of 26 patients with chronic heart failure showed that carvedilol (average daily dose 27.5 mg/d) caused a significant decrease in fasting insulin levels (17.09 to 10.77 microU/ml, p <0.05) compared to pre-treatment levels. This trial also showed that patients on carvedilol had significantly (p=0.015) lower fasting insulin levels (10.77 microU/ml) compared to the fasting insulin levels (20.72 microU/ml) of patients on bisoprolol treatment (5.9mg/d).(2) |
CARVEDILOL, CARVEDILOL ER, COREG, COREG CR, LABETALOL HCL, LABETALOL HCL-WATER |
| Selected Antidiabetic Agents/Chloroquine; Hydroxychloroquine SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown. Chloroquine and hydroxychloroquine may increase insulin sensitivity by inhibiting insulin metabolism and inflammation and increasing cellular uptake of glucose and glycogen synthesis.(1,2) These effects may result in additive hypoglycemia with anti-diabetic agents. CLINICAL EFFECTS: Concurrent use of chloroquine or hydroxychloroquine and antidiabetic agents may result in severe hypoglycemia.(3) Hypoglycemia can lead to coma. PREDISPOSING FACTORS: Elderly patients, especially those with decreased renal function may be predisposed to this interaction. PATIENT MANAGEMENT: Patients maintained on antidiabetic agents who require concurrent therapy with chloroquine or hydroxychloroquine should be closely monitored for hypoglycemia. A decrease in the dose of insulin or other anti-diabetic medications may be required. Patients should be advised of the risk and symptoms of hypoglycemia and to contact their doctor if hypoglycemia occurs.(3) Signs of hypoglycemia may include confusion, dizziness, feeling shaky, unusual hunger, headaches, irritability, pounding heart or very fast pulse, pale skin, sweating, trembling, weakness, or unusual anxiety. DISCUSSION: Hydroxychloroquine has been shown to cause severe hypoglycemia including loss of consciousness that could be life threatening.(3) Concomitant hypoglycemic agents may increase the risk and/or severity of this effect. A 77 year old man who was stable on twice daily insulin suffered two episodes of hypoglycemic coma 2 weeks after starting prednisone 5 mg daily and hydroxychloroquine 400 mg daily for rheumatoid arthritis. His insulin dosage required a decrease of 37%.(4) Many studies have investigated the glucose-lowering effect of hydroxychloroquine. In a clinical trial of type II diabetics on maximal doses of sulfonylureas, addition of hydroxychloroquine lowered hemoglobin A1C (HbA1C) up to 1% more than placebo.(5) Another clinical trial of type II diabetics on metformin and glimepiride or gliclazide found that hydroxychloroquine 400 mg daily reduced fasting blood glucose (FBG), post-prandial glucose (PPG), and HbA1C to a similar degree as pioglitazone 15 mg daily at 24 weeks.(6) In a prospective observational study, 250 uncontrolled type II diabetics on metformin, glimepiride, pioglitazone, sitagliptin, and a SGLT-2 inhibitor received hydroxychloroquine 400 mg daily for 48 weeks. HbA1C decreased from 8.83% to 6.44%, FBG decreased by 40.78%, and PPG decreased by 58.95%. The doses of metformin were reduced by 50%, glimepiride and sitagliptin by 75%, and SGLT-2 inhibitors were discontinued in most patients.(7) |
CHLOROQUINE PHOSPHATE, HYDROXYCHLOROQUINE SULFATE, PLAQUENIL, SOVUNA |
| Selected Antidiabetics/Safinamide SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism by which MAO inhibitors such as safinamide affect carbohydrate metabolism and subsequent enhancement of the hypoglycemic action of insulin is not clear. The adrenergic response to hypoglycemia may be blocked by insulin release caused by MAOI's. In vitro studies have shown that MAO inhibitors are capable of both potentiating and inhibiting insulin release, depending on their concentrations. Stimulation of glucose-mediated insulin secretion is believed to be related to the MAO inhibitory effects of the drugs. CLINICAL EFFECTS: The hypoglycemic response to both insulin and glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylurea may be increased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Concurrent MAO inhibitor therapy for depression in a diabetic patient will often require reduction in dosage of the hypoglycemic agent because of enhanced hypoglycemic effects. Since the extent of the reaction is highly unpredictable, any diabetic patients receiving MAO inhibitors should be monitored for possible excessive hypoglycemia. DISCUSSION: This interaction is likely to occur. The interaction between MAOIs and insulin is well documented. Additional documentation is necessary to confirm the potential interaction of MAOI's with other glucose lowering agents including alpha glucosidase inhibitors, meglitinides, and sulfonylureas but is expected to occur based on pharmacologic similarity. It may take several weeks for the full hypoglycemic effect of the MAOI to occur. Conversely, it may take several weeks for the effect to dissipate after stopping the MAOI. |
XADAGO |
| Anesthesia Agents/GLP-1 Receptor Agonists SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: GLP-1 receptor agonists can cause delayed gastric emptying.(1,2) CLINICAL EFFECTS: Gastric contents may remain in the stomach after preoperative fasting, which could increase the risk of regurgitation and aspiration.(1,2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The American Society of Anesthesiologists (ASA) recommends the following for patients receiving elective procedures: - For patients on daily dosing, consider holding GLP-1 agonists on the day of the procedure. For patients on weekly dosing, consider holding GLP-1 agonists a week prior to the procedure. - Consult an endocrinologist for patients taking GLP-1 agonists for diabetes management if the GLP-1 agonist is held longer than the dosing schedule to avoid hyperglycemia. - For patients requiring urgent or emergent procedures, proceed and treat the patient as 'full stomach.'(3) DISCUSSION: In one case report, a 31-year-old patient taking semaglutide followed preoperative fasting guidelines but food residue was discovered upon endoscopy, leading to cancellation of the surgical procedure.(4) In a case report, a semaglutide-treated patient experienced regurgitation upon induction of general anesthesia despite a 20 hour preoperative fasting period. The patient received semaglutide two days before the scheduled procedure.(5) A case report of a 42-year-old patient after fasting for 18 hours showed substantial gastric content upon endoscopy. The patient experienced intraoperative pulmonary aspiration of gastric contents which were suctioned from the trachea and bronchi using bronchoscopy.(6) |
AMIDATE, ANECTINE, ATRACURIUM BESYLATE, BREVITAL SODIUM, CISATRACURIUM BESYLATE, DESFLURANE, DEXMEDETOMIDINE HCL, DEXMEDETOMIDINE-0.9% NACL, DEXMEDETOMIDINE-D5W, DIPRIVAN, ETOMIDATE, FORANE, ISOFLURANE, METHOHEXITAL SODIUM, METHOHEXITAL-STERILE WATER, NIMBEX, PRECEDEX, PROPOFOL, QUELICIN, SEVOFLURANE, SUCCINYLCHOLINE CHLORIDE, SUCCINYLCHOLINE CHLORIDE-NACL, SUPRANE, TERRELL, ULTANE, VECURONIUM BROMIDE, VECURONIUM BROMIDE-WATER |
The following contraindication information is available for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
Drug contraindication overview.
Liraglutide alone or in fixed combination with insulin degludec (Xultophy(R)) is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Liraglutide alone or in fixed combination with insulin degludec also is contraindicated in patients with a history of serious hypersensitivity to liraglutide or to any of the product components. The fixed combination of insulin degludec and liraglutide is contraindicated during episodes of hypoglycemia.
Liraglutide is contraindicated forchronic weight management in women who are pregnant. *Insulin degludec alone or in fixed combination with liraglutide is contraindicated in patients with known hypersensitivity to insulin degludec or to any ingredient in the formulation. *Insulin degludec alone or in fixed combination with liraglutide also is contraindicated during episodes of hypoglycemia.
*The fixed combination of insulin degludec and liraglutide is contraindicated (with a Boxed Warning) in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with multiple endocrine neoplasia type 2 (MEN 2) due to the liraglutide component. Liraglutide causes dose- and treatment duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice.
Liraglutide alone or in fixed combination with insulin degludec (Xultophy(R)) is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) and in patients with multiple endocrine neoplasia syndrome type 2 (MEN 2). Liraglutide alone or in fixed combination with insulin degludec also is contraindicated in patients with a history of serious hypersensitivity to liraglutide or to any of the product components. The fixed combination of insulin degludec and liraglutide is contraindicated during episodes of hypoglycemia.
Liraglutide is contraindicated forchronic weight management in women who are pregnant. *Insulin degludec alone or in fixed combination with liraglutide is contraindicated in patients with known hypersensitivity to insulin degludec or to any ingredient in the formulation. *Insulin degludec alone or in fixed combination with liraglutide also is contraindicated during episodes of hypoglycemia.
*The fixed combination of insulin degludec and liraglutide is contraindicated (with a Boxed Warning) in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with multiple endocrine neoplasia type 2 (MEN 2) due to the liraglutide component. Liraglutide causes dose- and treatment duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice.
There are 4 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Acute pancreatitis |
| Family history of medullary thyroid carcinoma |
| Medullary thyroid carcinoma |
| Multiple endocrine neoplasia type 2 |
There are 4 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| C-cell hyperplasia of thyroid |
| Gastroparesis |
| Hypoglycemic disorder |
| Pregnancy |
There are 5 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Disease of liver |
| Hypoglycemic disorder |
| Hypokalemia |
| Kidney disease with likely reduction in glomerular filtration rate (GFr) |
| Kidney disease with reduction in glomerular filtration rate (GFr) |
The following adverse reaction information is available for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
Adverse reaction overview.
The most common adverse effects associated with insulin degludec include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain. Adverse effects reported in at least 5% of patients receiving liraglutide monotherapy for the management of type 2 diabetes mellitus in clinical trials include nausea, diarrhea, vomiting, constipation, and headache. Adverse effects reported in at least 2% of patients receiving liraglutide for the management of obesity and more frequently than with placebo include nausea, hypoglycemia (in patients with both obesity and type 2 diabetes mellitus), headache, diarrhea, constipation, dizziness, fatigue, vomiting, gastroenteritis, abdominal pain, urinary tract infection, abdominal distention, dyspepsia, upper abdominal pain, flatulence, decreased appetite, increased lipase, gastroesophageal reflux disease, insomnia, anxiety, viral gastroenteritis, dry mouth, asthenia, injection site reaction, eructation, and injection site erythema. Adverse effects occurring in at least 5% of patients with type 2 diabetes mellitus who received the fixed combination of insulin degludec and liraglutide include nasopharyngitis, headache, nausea, diarrhea, increased lipase concentrations, and upper respiratory tract infection.
The most common adverse effects associated with insulin degludec include hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain. Adverse effects reported in at least 5% of patients receiving liraglutide monotherapy for the management of type 2 diabetes mellitus in clinical trials include nausea, diarrhea, vomiting, constipation, and headache. Adverse effects reported in at least 2% of patients receiving liraglutide for the management of obesity and more frequently than with placebo include nausea, hypoglycemia (in patients with both obesity and type 2 diabetes mellitus), headache, diarrhea, constipation, dizziness, fatigue, vomiting, gastroenteritis, abdominal pain, urinary tract infection, abdominal distention, dyspepsia, upper abdominal pain, flatulence, decreased appetite, increased lipase, gastroesophageal reflux disease, insomnia, anxiety, viral gastroenteritis, dry mouth, asthenia, injection site reaction, eructation, and injection site erythema. Adverse effects occurring in at least 5% of patients with type 2 diabetes mellitus who received the fixed combination of insulin degludec and liraglutide include nasopharyngitis, headache, nausea, diarrhea, increased lipase concentrations, and upper respiratory tract infection.
There are 40 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Hypoglycemic disorder |
Biliary calculus Elevated serum amylase Hyperbilirubinemia Hypersensitivity drug reaction Hypertension Hypotension |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Acute pancreatitis Acute renal failure Anaphylaxis Angioedema Atrioventricular block Bronchospastic pulmonary disease Bundle branch block Cholecystitis Cholestasis Colorectal cancer Dehydration Dyspnea Fecal impaction Gastrointestinal obstruction Heart block Hepatitis Hypersensitivity drug reaction Hypoglycemic disorder Hypokalemia Hypotension Ileus Increased alanine transaminase Increased aspartate transaminase Kidney disease with reduction in glomerular filtration rate (GFr) Localized cutaneous amyloidosis Medullary thyroid carcinoma Necrotizing pancreatitis Orthostatic hypotension Papillary thyroid carcinoma Suicidal ideation Tongue swelling Urticaria |
There are 55 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Acute abdominal pain Anorexia Constipation Diarrhea Dizziness Dyspepsia Elevated serum lipase Fatigue Fever Gastroenteritis Headache disorder Injection site sequelae Nausea Pharyngitis Vomiting Weight loss |
Abdominal distension Back pain Bronchitis Cataracts Cough Depression Edema Eructation Flatulence Gastroesophageal reflux disease General weakness Injection site sequelae Insomnia Lipodystrophy Malaise Peripheral edema Rhinitis Sinusitis Skin rash Symptoms of anxiety Tachycardia Upper respiratory infection Urinary tract infection Weight gain Xerostomia |
| Rare/Very Rare |
|---|
|
Alopecia Body fluid retention Depression Diarrhea Dysesthesia Dysgeusia Headache disorder Lip swelling Localized cutaneous amyloidosis Pruritus of skin Skin rash Subcutaneous nodules Upper respiratory infection Urticaria |
The following precautions are available for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
Safety and efficacy of insulin degludec have not been established in pediatric patients younger than 1 year of age. For pediatric patients requiring less than 5 units of insulin degludec per day, only the U-100 vial should be used. In pediatric patients whose therapy is being transferred from another long- or intermediate-acting insulin to insulin degludec, the drug should be initiated at a reduced dosage to minimize the risk of hypoglycemia.
Safety and efficacy of insulin degludec in pediatric patients 1 year of age and older are based on a noninferiority clinical study of 12 months' duration in patients 1-17 years of age with type 1 diabetes mellitus, a pharmacokinetic study that included approximately 200 patients 1-17 years of age with type 1 diabetes mellitus, and data from clinical trials conducted in adults with type 2 diabetes mellitus. In the noninferiority study, insulin degludec and insulin detemir provided similar glycemic control (as determined by glycosylated hemoglobin (hemoglobin A1c, HbA1c)). Adverse effects reported in pediatric patients with type 1 diabetes mellitus who were receiving insulin degludec therapy were similar to those reported in adults.
Safety and efficacy of the fixed combination of insulin degludec and liraglutide have not been established in pediatric patients. Safety and efficacy of liraglutide for the management of type 2 diabetes mellitus have not been established in children or adolescents younger than 10 years of age. Safety and efficacy of liraglutide for chronic weight management have not been established in children or adolescents younger than 18 years of age, and the manufacturer of Saxenda(R) states that the drug is not recommended for use in pediatric patients. Safety and efficacy of the fixed combination of insulin degludec and liraglutide have not been established in pediatric patients.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Safety and efficacy of insulin degludec in pediatric patients 1 year of age and older are based on a noninferiority clinical study of 12 months' duration in patients 1-17 years of age with type 1 diabetes mellitus, a pharmacokinetic study that included approximately 200 patients 1-17 years of age with type 1 diabetes mellitus, and data from clinical trials conducted in adults with type 2 diabetes mellitus. In the noninferiority study, insulin degludec and insulin detemir provided similar glycemic control (as determined by glycosylated hemoglobin (hemoglobin A1c, HbA1c)). Adverse effects reported in pediatric patients with type 1 diabetes mellitus who were receiving insulin degludec therapy were similar to those reported in adults.
Safety and efficacy of the fixed combination of insulin degludec and liraglutide have not been established in pediatric patients. Safety and efficacy of liraglutide for the management of type 2 diabetes mellitus have not been established in children or adolescents younger than 10 years of age. Safety and efficacy of liraglutide for chronic weight management have not been established in children or adolescents younger than 18 years of age, and the manufacturer of Saxenda(R) states that the drug is not recommended for use in pediatric patients. Safety and efficacy of the fixed combination of insulin degludec and liraglutide have not been established in pediatric patients.
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Available data from one unpublished trial and the published literature with insulin degludec use during pregnancy have not identified a drug-associated risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. In a randomized, parallel-group, open-label active-controlled clinical trial in 91 pregnant women with type 1 diabetes mellitus who received insulin degludec once daily and insulin aspart beginning in gestational weeks 8--13 or prior to conception, no clear evidence of maternal or fetal risk associated with insulin degludec use was observed. In about two-thirds of infants, insulin degludec was detected in the infant cord blood at levels at the lower level of quantification of the assay.
In reproduction studies in animals, insulin degludec caused pre- and post-implantation loss and visceral/skeletal abnormalities in the offspring of pregnant rats and rabbits at maternal plasma concentrations 5-10 times higher than those achieved with a subcutaneous human dosage of 0.75 units/kg per day. The manufacturer states that these effects are probably secondary to maternal hypoglycemia.
Data are lacking on the use of the fixed combination of insulin degludec and liraglutide in pregnant women. Animal studies suggest that there may be risks to the fetus from exposure to liraglutide during pregnancy. Poorly controlled diabetes mellitus in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications.
Poorly controlled diabetes mellitus also increases the fetal risk for major birth defects, still birth, and macrosomia related morbidity. Insulin degludec and the fixed combination of insulin degludec and liraglutide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Data are lacking on the use of liraglutide (Victoza(R)) in pregnant women.
Reproduction studies in rats using liraglutide at dosages resulting in systemic exposures 0.8 times the exposure from the maximum recommended human dosage (1.8 mg daily) have shown teratogenic effects. Studies in rabbits have shown reduced growth and major abnormalities at systemic exposures below the maximum recommended human dosage.
Liraglutide for the management of diabetes mellitus should be used during pregnancy only when the potential benefits justify the possible risks to the fetus. The manufacturer states that liraglutide (Saxenda(R)) is contraindicated for the management of obesity in women who are pregnant because weight loss offers no potential benefit to pregnant women and may result in fetal harm. If a woman taking liraglutide for the management of obesity becomes pregnant or plans to become pregnant, the drug should be discontinued.
In reproduction studies in animals, insulin degludec caused pre- and post-implantation loss and visceral/skeletal abnormalities in the offspring of pregnant rats and rabbits at maternal plasma concentrations 5-10 times higher than those achieved with a subcutaneous human dosage of 0.75 units/kg per day. The manufacturer states that these effects are probably secondary to maternal hypoglycemia.
Data are lacking on the use of the fixed combination of insulin degludec and liraglutide in pregnant women. Animal studies suggest that there may be risks to the fetus from exposure to liraglutide during pregnancy. Poorly controlled diabetes mellitus in pregnancy increases the maternal risk for diabetic ketoacidosis, pre-eclampsia, spontaneous abortions, preterm delivery, and delivery complications.
Poorly controlled diabetes mellitus also increases the fetal risk for major birth defects, still birth, and macrosomia related morbidity. Insulin degludec and the fixed combination of insulin degludec and liraglutide should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Data are lacking on the use of liraglutide (Victoza(R)) in pregnant women.
Reproduction studies in rats using liraglutide at dosages resulting in systemic exposures 0.8 times the exposure from the maximum recommended human dosage (1.8 mg daily) have shown teratogenic effects. Studies in rabbits have shown reduced growth and major abnormalities at systemic exposures below the maximum recommended human dosage.
Liraglutide for the management of diabetes mellitus should be used during pregnancy only when the potential benefits justify the possible risks to the fetus. The manufacturer states that liraglutide (Saxenda(R)) is contraindicated for the management of obesity in women who are pregnant because weight loss offers no potential benefit to pregnant women and may result in fetal harm. If a woman taking liraglutide for the management of obesity becomes pregnant or plans to become pregnant, the drug should be discontinued.
Insulin degludec is distributed into milk in rats; it is not known whether the drug is distributed into human milk. Liraglutide also is distributed into milk in lactating rats. The effects of insulin degludec on the breast-fed infant or on milk production are not known.
The benefits of breast-feeding and the importance of insulin degludec alone or with liraglutide to the mother should be considered along with any potential adverse effects on the breast-fed infant from the drug or from the underlying maternal condition. Liraglutide is distributed into milk in rats. It is not known whether liraglutide is distributed into milk in humans; a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.
The benefits of breast-feeding and the importance of insulin degludec alone or with liraglutide to the mother should be considered along with any potential adverse effects on the breast-fed infant from the drug or from the underlying maternal condition. Liraglutide is distributed into milk in rats. It is not known whether liraglutide is distributed into milk in humans; a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman.
In controlled clinical trials of insulin degludec, 77 (7%) patients with type 1 diabetes mellitus were >=65 years of age and 9 (1%) were >=75 years of age; in patients with type 2 diabetes, 670 (25%) were >=65 years of age and 80 (3%) were >=75 years of age. In a safety outcomes trial, 1983 (52%) of patients with type 2 diabetes mellitus who received insulin degludec were >=65 years of age and 381 (10%) were >=75 years of age. No substantial differences in safety and efficacy of insulin degludec or the fixed combination of insulin degludec and liraglutide have been observed in geriatric patients relative to younger patients; however, increased sensitivity of some older patients cannot be ruled out.
Data indicate that the pharmacokinetic and pharmacodynamic properties of insulin degludec at steady sate are similar in younger adults and geriatric patients; however, greater between-subject variability has been observed among geriatric patients. In clinical studies of the fixed combination of insulin degludec and liraglutide in 1881 patients, 375 (19.9%) were >=65 years of age and 52 (2.8 %) were >=75 years of age. No overall differences in the safety, efficacy, or pharmacokinetics of the fixed combination of insulin degludec and liraglutide were observed between patients >=65 years of age and older and younger patients.
Initial dosage, dose increments, and maintenance dosage should be conservative to avoid hypoglycemia. Hypoglycemia may be difficult to recognize in geriatric patients. No substantial differences in safety and efficacy relative to younger adults have been observed with liraglutide or the fixed combination of insulin degludec and liraglutide, but increased sensitivity of some older patients cannot be ruled out. Hypoglycemia may be difficult to recognize in geriatric patients.
Data indicate that the pharmacokinetic and pharmacodynamic properties of insulin degludec at steady sate are similar in younger adults and geriatric patients; however, greater between-subject variability has been observed among geriatric patients. In clinical studies of the fixed combination of insulin degludec and liraglutide in 1881 patients, 375 (19.9%) were >=65 years of age and 52 (2.8 %) were >=75 years of age. No overall differences in the safety, efficacy, or pharmacokinetics of the fixed combination of insulin degludec and liraglutide were observed between patients >=65 years of age and older and younger patients.
Initial dosage, dose increments, and maintenance dosage should be conservative to avoid hypoglycemia. Hypoglycemia may be difficult to recognize in geriatric patients. No substantial differences in safety and efficacy relative to younger adults have been observed with liraglutide or the fixed combination of insulin degludec and liraglutide, but increased sensitivity of some older patients cannot be ruled out. Hypoglycemia may be difficult to recognize in geriatric patients.
The following prioritized warning is available for XULTOPHY 100/3.6 (insulin degludec/liraglutide):
WARNING: This medication can cause a certain type of thyroid tumor (thyroid C-cell tumors) in rats and mice. It is unknown if this medication can cause similar tumors in humans. Talk with your doctor about the benefits and risks of treatment with this medication.
Do not use this medication if you have a certain inherited disease (multiple endocrine neoplasia syndrome type 2 or MEN 2) or if you have a personal/family history of a certain type of cancer (medullary thyroid carcinoma). While using this medication, tell your doctor right away if you notice any signs or symptoms of thyroid tumors, including unusual growth or lump in the neck, difficulty swallowing, shortness of breath, or unusual/lasting hoarseness.
WARNING: This medication can cause a certain type of thyroid tumor (thyroid C-cell tumors) in rats and mice. It is unknown if this medication can cause similar tumors in humans. Talk with your doctor about the benefits and risks of treatment with this medication.
Do not use this medication if you have a certain inherited disease (multiple endocrine neoplasia syndrome type 2 or MEN 2) or if you have a personal/family history of a certain type of cancer (medullary thyroid carcinoma). While using this medication, tell your doctor right away if you notice any signs or symptoms of thyroid tumors, including unusual growth or lump in the neck, difficulty swallowing, shortness of breath, or unusual/lasting hoarseness.
The following icd codes are available for XULTOPHY 100/3.6 (insulin degludec/liraglutide)'s list of indications:
| Type 2 diabetes mellitus | |
| E08 | Diabetes mellitus due to underlying condition |
| E08.0 | Diabetes mellitus due to underlying condition with hyperosmolarity |
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma |
| E08.1 | Diabetes mellitus due to underlying condition with ketoacidosis |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma |
| E08.2 | Diabetes mellitus due to underlying condition with kidney complications |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy |
| E08.22 | Diabetes mellitus due to underlying condition with diabetic chronic kidney disease |
| E08.29 | Diabetes mellitus due to underlying condition with other diabetic kidney complication |
| E08.3 | Diabetes mellitus due to underlying condition with ophthalmic complications |
| E08.31 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema |
| E08.32 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy |
| E08.321 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E08.3219 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.329 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E08.3293 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E08.3299 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.33 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy |
| E08.331 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema |
| E08.3311 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E08.3312 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E08.3313 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E08.3319 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.339 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema |
| E08.3391 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E08.3392 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E08.3393 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E08.3399 | Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.34 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy |
| E08.341 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema |
| E08.3411 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E08.3412 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E08.3413 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E08.3419 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.349 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema |
| E08.3491 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E08.3492 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E08.3493 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E08.3499 | Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.35 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy |
| E08.351 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema |
| E08.3511 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, right eye |
| E08.3512 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, left eye |
| E08.3513 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, bilateral |
| E08.3519 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E08.352 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E08.3521 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E08.3522 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E08.3523 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E08.3529 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E08.353 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E08.3531 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E08.3532 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E08.3533 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E08.3539 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E08.354 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E08.3541 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E08.3542 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E08.3543 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E08.3549 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E08.355 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy |
| E08.3551 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye |
| E08.3552 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye |
| E08.3553 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral |
| E08.3559 | Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye |
| E08.359 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema |
| E08.3591 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, right eye |
| E08.3592 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, left eye |
| E08.3593 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, bilateral |
| E08.3599 | Diabetes mellitus due to underlying condition with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E08.36 | Diabetes mellitus due to underlying condition with diabetic cataract |
| E08.37 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment |
| E08.37x1 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye |
| E08.37x2 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye |
| E08.37x3 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral |
| E08.37x9 | Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye |
| E08.39 | Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication |
| E08.4 | Diabetes mellitus due to underlying condition with neurological complications |
| E08.40 | Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified |
| E08.41 | Diabetes mellitus due to underlying condition with diabetic mononeuropathy |
| E08.42 | Diabetes mellitus due to underlying condition with diabetic polyneuropathy |
| E08.43 | Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy |
| E08.44 | Diabetes mellitus due to underlying condition with diabetic amyotrophy |
| E08.49 | Diabetes mellitus due to underlying condition with other diabetic neurological complication |
| E08.5 | Diabetes mellitus due to underlying condition with circulatory complications |
| E08.51 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene |
| E08.52 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene |
| E08.59 | Diabetes mellitus due to underlying condition with other circulatory complications |
| E08.6 | Diabetes mellitus due to underlying condition with other specified complications |
| E08.61 | Diabetes mellitus due to underlying condition with diabetic arthropathy |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy |
| E08.618 | Diabetes mellitus due to underlying condition with other diabetic arthropathy |
| E08.62 | Diabetes mellitus due to underlying condition with skin complications |
| E08.620 | Diabetes mellitus due to underlying condition with diabetic dermatitis |
| E08.621 | Diabetes mellitus due to underlying condition with foot ulcer |
| E08.622 | Diabetes mellitus due to underlying condition with other skin ulcer |
| E08.628 | Diabetes mellitus due to underlying condition with other skin complications |
| E08.63 | Diabetes mellitus due to underlying condition with oral complications |
| E08.630 | Diabetes mellitus due to underlying condition with periodontal disease |
| E08.638 | Diabetes mellitus due to underlying condition with other oral complications |
| E08.64 | Diabetes mellitus due to underlying condition with hypoglycemia |
| E08.641 | Diabetes mellitus due to underlying condition with hypoglycemia with coma |
| E08.649 | Diabetes mellitus due to underlying condition with hypoglycemia without coma |
| E08.65 | Diabetes mellitus due to underlying condition with hyperglycemia |
| E08.69 | Diabetes mellitus due to underlying condition with other specified complication |
| E08.8 | Diabetes mellitus due to underlying condition with unspecified complications |
| E08.9 | Diabetes mellitus due to underlying condition without complications |
| E09 | Drug or chemical induced diabetes mellitus |
| E09.0 | Drug or chemical induced diabetes mellitus with hyperosmolarity |
| E09.00 | Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E09.01 | Drug or chemical induced diabetes mellitus with hyperosmolarity with coma |
| E09.1 | Drug or chemical induced diabetes mellitus with ketoacidosis |
| E09.10 | Drug or chemical induced diabetes mellitus with ketoacidosis without coma |
| E09.11 | Drug or chemical induced diabetes mellitus with ketoacidosis with coma |
| E09.2 | Drug or chemical induced diabetes mellitus with kidney complications |
| E09.21 | Drug or chemical induced diabetes mellitus with diabetic nephropathy |
| E09.22 | Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease |
| E09.29 | Drug or chemical induced diabetes mellitus with other diabetic kidney complication |
| E09.3 | Drug or chemical induced diabetes mellitus with ophthalmic complications |
| E09.31 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy |
| E09.311 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E09.319 | Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E09.32 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy |
| E09.321 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E09.3211 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E09.3212 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E09.3213 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E09.3219 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.329 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E09.3291 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E09.3292 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E09.3293 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E09.3299 | Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.33 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy |
| E09.331 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E09.3311 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E09.3312 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E09.3313 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E09.3319 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.339 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E09.3391 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E09.3392 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E09.3393 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E09.3399 | Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.34 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy |
| E09.341 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E09.3411 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E09.3412 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E09.3413 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E09.3419 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.349 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E09.3491 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E09.3492 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E09.3493 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E09.3499 | Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.35 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy |
| E09.351 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E09.3511 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E09.3512 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E09.3513 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E09.3519 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E09.352 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E09.3521 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E09.3522 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E09.3523 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E09.3529 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E09.353 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E09.3531 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E09.3532 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E09.3533 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E09.3539 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E09.354 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E09.3541 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E09.3542 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E09.3543 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E09.3549 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E09.355 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy |
| E09.3551 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E09.3552 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E09.3553 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E09.3559 | Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E09.359 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E09.3591 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E09.3592 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E09.3593 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E09.3599 | Drug or chemical induced diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E09.36 | Drug or chemical induced diabetes mellitus with diabetic cataract |
| E09.37 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment |
| E09.37x1 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E09.37x2 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E09.37x3 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E09.37x9 | Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E09.39 | Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication |
| E09.4 | Drug or chemical induced diabetes mellitus with neurological complications |
| E09.40 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified |
| E09.41 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy |
| E09.42 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy |
| E09.43 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy |
| E09.44 | Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy |
| E09.49 | Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication |
| E09.5 | Drug or chemical induced diabetes mellitus with circulatory complications |
| E09.51 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E09.52 | Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E09.59 | Drug or chemical induced diabetes mellitus with other circulatory complications |
| E09.6 | Drug or chemical induced diabetes mellitus with other specified complications |
| E09.61 | Drug or chemical induced diabetes mellitus with diabetic arthropathy |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy |
| E09.618 | Drug or chemical induced diabetes mellitus with other diabetic arthropathy |
| E09.62 | Drug or chemical induced diabetes mellitus with skin complications |
| E09.620 | Drug or chemical induced diabetes mellitus with diabetic dermatitis |
| E09.621 | Drug or chemical induced diabetes mellitus with foot ulcer |
| E09.622 | Drug or chemical induced diabetes mellitus with other skin ulcer |
| E09.628 | Drug or chemical induced diabetes mellitus with other skin complications |
| E09.63 | Drug or chemical induced diabetes mellitus with oral complications |
| E09.630 | Drug or chemical induced diabetes mellitus with periodontal disease |
| E09.638 | Drug or chemical induced diabetes mellitus with other oral complications |
| E09.64 | Drug or chemical induced diabetes mellitus with hypoglycemia |
| E09.641 | Drug or chemical induced diabetes mellitus with hypoglycemia with coma |
| E09.649 | Drug or chemical induced diabetes mellitus with hypoglycemia without coma |
| E09.65 | Drug or chemical induced diabetes mellitus with hyperglycemia |
| E09.69 | Drug or chemical induced diabetes mellitus with other specified complication |
| E09.8 | Drug or chemical induced diabetes mellitus with unspecified complications |
| E09.9 | Drug or chemical induced diabetes mellitus without complications |
| E11 | Type 2 diabetes mellitus |
| E11.0 | Type 2 diabetes mellitus with hyperosmolarity |
| E11.00 | Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E11.01 | Type 2 diabetes mellitus with hyperosmolarity with coma |
| E11.1 | Type 2 diabetes mellitus with ketoacidosis |
| E11.10 | Type 2 diabetes mellitus with ketoacidosis without coma |
| E11.11 | Type 2 diabetes mellitus with ketoacidosis with coma |
| E11.2 | Type 2 diabetes mellitus with kidney complications |
| E11.21 | Type 2 diabetes mellitus with diabetic nephropathy |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
| E11.29 | Type 2 diabetes mellitus with other diabetic kidney complication |
| E11.3 | Type 2 diabetes mellitus with ophthalmic complications |
| E11.31 | Type 2 diabetes mellitus with unspecified diabetic retinopathy |
| E11.311 | Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E11.319 | Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E11.32 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy |
| E11.321 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E11.3211 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3212 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3213 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3219 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.329 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E11.3291 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3292 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3293 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3299 | Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.33 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy |
| E11.331 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E11.3311 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3312 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3313 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3319 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.339 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E11.3391 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3392 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3393 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3399 | Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.34 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy |
| E11.341 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E11.3411 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E11.3412 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E11.3413 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E11.3419 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.349 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E11.3491 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E11.3492 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E11.3493 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E11.3499 | Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.35 | Type 2 diabetes mellitus with proliferative diabetic retinopathy |
| E11.351 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E11.3511 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E11.3512 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E11.3513 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E11.3519 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E11.352 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E11.3521 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E11.3522 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E11.3523 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E11.3529 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E11.353 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E11.3531 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E11.3532 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E11.3533 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E11.3539 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E11.354 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E11.3541 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E11.3542 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E11.3543 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E11.3549 | Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E11.355 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy |
| E11.3551 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E11.3552 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E11.3553 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E11.3559 | Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E11.359 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E11.3591 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E11.3592 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E11.3593 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E11.3599 | Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E11.36 | Type 2 diabetes mellitus with diabetic cataract |
| E11.37 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment |
| E11.37x1 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E11.37x2 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E11.37x3 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E11.37x9 | Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E11.39 | Type 2 diabetes mellitus with other diabetic ophthalmic complication |
| E11.4 | Type 2 diabetes mellitus with neurological complications |
| E11.40 | Type 2 diabetes mellitus with diabetic neuropathy, unspecified |
| E11.41 | Type 2 diabetes mellitus with diabetic mononeuropathy |
| E11.42 | Type 2 diabetes mellitus with diabetic polyneuropathy |
| E11.43 | Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E11.44 | Type 2 diabetes mellitus with diabetic amyotrophy |
| E11.49 | Type 2 diabetes mellitus with other diabetic neurological complication |
| E11.5 | Type 2 diabetes mellitus with circulatory complications |
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E11.52 | Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E11.59 | Type 2 diabetes mellitus with other circulatory complications |
| E11.6 | Type 2 diabetes mellitus with other specified complications |
| E11.61 | Type 2 diabetes mellitus with diabetic arthropathy |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy |
| E11.618 | Type 2 diabetes mellitus with other diabetic arthropathy |
| E11.62 | Type 2 diabetes mellitus with skin complications |
| E11.620 | Type 2 diabetes mellitus with diabetic dermatitis |
| E11.621 | Type 2 diabetes mellitus with foot ulcer |
| E11.622 | Type 2 diabetes mellitus with other skin ulcer |
| E11.628 | Type 2 diabetes mellitus with other skin complications |
| E11.63 | Type 2 diabetes mellitus with oral complications |
| E11.630 | Type 2 diabetes mellitus with periodontal disease |
| E11.638 | Type 2 diabetes mellitus with other oral complications |
| E11.64 | Type 2 diabetes mellitus with hypoglycemia |
| E11.641 | Type 2 diabetes mellitus with hypoglycemia with coma |
| E11.649 | Type 2 diabetes mellitus with hypoglycemia without coma |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| E11.69 | Type 2 diabetes mellitus with other specified complication |
| E11.8 | Type 2 diabetes mellitus with unspecified complications |
| E11.9 | Type 2 diabetes mellitus without complications |
| E13 | Other specified diabetes mellitus |
| E13.0 | Other specified diabetes mellitus with hyperosmolarity |
| E13.00 | Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHc) |
| E13.01 | Other specified diabetes mellitus with hyperosmolarity with coma |
| E13.1 | Other specified diabetes mellitus with ketoacidosis |
| E13.10 | Other specified diabetes mellitus with ketoacidosis without coma |
| E13.11 | Other specified diabetes mellitus with ketoacidosis with coma |
| E13.2 | Other specified diabetes mellitus with kidney complications |
| E13.21 | Other specified diabetes mellitus with diabetic nephropathy |
| E13.22 | Other specified diabetes mellitus with diabetic chronic kidney disease |
| E13.29 | Other specified diabetes mellitus with other diabetic kidney complication |
| E13.3 | Other specified diabetes mellitus with ophthalmic complications |
| E13.31 | Other specified diabetes mellitus with unspecified diabetic retinopathy |
| E13.311 | Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema |
| E13.319 | Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema |
| E13.32 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy |
| E13.321 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema |
| E13.3211 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye |
| E13.3212 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye |
| E13.3213 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral |
| E13.3219 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.329 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema |
| E13.3291 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye |
| E13.3292 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye |
| E13.3293 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral |
| E13.3299 | Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.33 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy |
| E13.331 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema |
| E13.3311 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye |
| E13.3312 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye |
| E13.3313 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral |
| E13.3319 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.339 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema |
| E13.3391 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye |
| E13.3392 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye |
| E13.3393 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral |
| E13.3399 | Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.34 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy |
| E13.341 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema |
| E13.3411 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye |
| E13.3412 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye |
| E13.3413 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral |
| E13.3419 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.349 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema |
| E13.3491 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye |
| E13.3492 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye |
| E13.3493 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral |
| E13.3499 | Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.35 | Other specified diabetes mellitus with proliferative diabetic retinopathy |
| E13.351 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema |
| E13.3511 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye |
| E13.3512 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye |
| E13.3513 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral |
| E13.3519 | Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye |
| E13.352 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula |
| E13.3521 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye |
| E13.3522 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye |
| E13.3523 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral |
| E13.3529 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye |
| E13.353 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula |
| E13.3531 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye |
| E13.3532 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye |
| E13.3533 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral |
| E13.3539 | Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye |
| E13.354 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment |
| E13.3541 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye |
| E13.3542 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye |
| E13.3543 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral |
| E13.3549 | Other specified diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye |
| E13.355 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy |
| E13.3551 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, right eye |
| E13.3552 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, left eye |
| E13.3553 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral |
| E13.3559 | Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye |
| E13.359 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema |
| E13.3591 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye |
| E13.3592 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye |
| E13.3593 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral |
| E13.3599 | Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye |
| E13.36 | Other specified diabetes mellitus with diabetic cataract |
| E13.37 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment |
| E13.37x1 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, right eye |
| E13.37x2 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, left eye |
| E13.37x3 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral |
| E13.37x9 | Other specified diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye |
| E13.39 | Other specified diabetes mellitus with other diabetic ophthalmic complication |
| E13.4 | Other specified diabetes mellitus with neurological complications |
| E13.40 | Other specified diabetes mellitus with diabetic neuropathy, unspecified |
| E13.41 | Other specified diabetes mellitus with diabetic mononeuropathy |
| E13.42 | Other specified diabetes mellitus with diabetic polyneuropathy |
| E13.43 | Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E13.44 | Other specified diabetes mellitus with diabetic amyotrophy |
| E13.49 | Other specified diabetes mellitus with other diabetic neurological complication |
| E13.5 | Other specified diabetes mellitus with circulatory complications |
| E13.51 | Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E13.52 | Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene |
| E13.59 | Other specified diabetes mellitus with other circulatory complications |
| E13.6 | Other specified diabetes mellitus with other specified complications |
| E13.61 | Other specified diabetes mellitus with diabetic arthropathy |
| E13.610 | Other specified diabetes mellitus with diabetic neuropathic arthropathy |
| E13.618 | Other specified diabetes mellitus with other diabetic arthropathy |
| E13.62 | Other specified diabetes mellitus with skin complications |
| E13.620 | Other specified diabetes mellitus with diabetic dermatitis |
| E13.621 | Other specified diabetes mellitus with foot ulcer |
| E13.622 | Other specified diabetes mellitus with other skin ulcer |
| E13.628 | Other specified diabetes mellitus with other skin complications |
| E13.63 | Other specified diabetes mellitus with oral complications |
| E13.630 | Other specified diabetes mellitus with periodontal disease |
| E13.638 | Other specified diabetes mellitus with other oral complications |
| E13.64 | Other specified diabetes mellitus with hypoglycemia |
| E13.641 | Other specified diabetes mellitus with hypoglycemia with coma |
| E13.649 | Other specified diabetes mellitus with hypoglycemia without coma |
| E13.65 | Other specified diabetes mellitus with hyperglycemia |
| E13.69 | Other specified diabetes mellitus with other specified complication |
| E13.8 | Other specified diabetes mellitus with unspecified complications |
| E13.9 | Other specified diabetes mellitus without complications |
Formulary Reference Tool