tolazamide (Rx)

Brand and Other Names:Tolinase
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 250mg
  • 500mg

Type 2 Diabetes

100-250 mg PO qDay or q12hr

Increase dose by 100-250 mg/day at weekly intervals to response; not to exceed 1 g/day

Fasting blood sugar <200 mg/dL

  • 100 mg/day PO

Fasting blood sugar >200 mg/dL

  • 250 mg/day PO

Malnurished, underweight, not eating properly, or elderly

  • 100 mg/day PO

Safety and efficacy not established

Type 2 diabetes

100-250 mg PO qDay or q12hr

Increase dose by 100-250 mg/day at weekly intervals to response; not to exceed 1 g/day

Fasting blood sugar <200 mg/dL

- 100 mg/day PO

Fasting blood sugar >200 mg/dL

- 250 mg/day PO

Malnurished, underweight, not eating properly, or elderly

- 100 mg/day PO

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Interactions

Interaction Checker

and tolazamide

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            Contraindicated (0)

              Serious - Use Alternative (5)

              • aminolevulinic acid oral

                aminolevulinic acid oral, tolazamide. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid administering other phototoxic drugs with aminolevulinic acid oral for 24 hr during perioperative period.

              • aminolevulinic acid topical

                tolazamide increases toxicity of aminolevulinic acid topical by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration of photosensitizing drugs may enhance the phototoxic reaction to photodynamic therapy with aminolevulinic acid.

              • ethanol

                ethanol, tolazamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

              • lumacaftor/ivacaftor

                lumacaftor/ivacaftor will decrease the level or effect of tolazamide by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. Sulfonylureas are CYP2C9 substrates. Lumacaftor/ivacaftor has the potential to induce CYP2C9.

              • methyl aminolevulinate

                tolazamide, methyl aminolevulinate. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Each drug may increase the photosensitizing effect of the other.

              Monitor Closely (137)

              • aceclofenac

                aceclofenac increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • acemetacin

                acemetacin increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • albiglutide

                albiglutide, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serious hypoglycemia may occur when insulin secretagogues and GLP-1 agonists are concurrently administered. Consider lowering the dose of insulin secretagogue to reduce the risk of hypoglycemia. .

              • alogliptin

                alogliptin, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of alogliptin with insulin and/or insulin secretagogues (eg, sulfonylureas, meglitinide derivatives) may increase risk for hypoglycemia; may require lower dose of insulin or insulin secretagogue .

              • aripiprazole

                aripiprazole, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • asenapine

                asenapine, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • aspirin

                aspirin increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • aspirin rectal

                aspirin rectal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • atazanavir

                atazanavir decreases effects of tolazamide by Other (see comment). Use Caution/Monitor. Comment: Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

              • benazepril

                benazepril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • bexarotene

                bexarotene increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Based on the mechanism of action, bexarotene capsules may increase the action of insulin enhancing agents, resulting in hypoglycemia. Hypoglycemia has not been associated with bexarotene monotherapy.

              • bitter melon

                bitter melon increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypoglycemia.

              • canagliflozin

                tolazamide, canagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with canagliflozin.

              • captopril

                captopril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • celecoxib

                celecoxib increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • cinnamon

                cinnamon increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Potential for hypoglycemia.

              • ciprofibrate

                ciprofibrate increases effects of tolazamide by plasma protein binding competition. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

              • ciprofloxacin

                ciprofloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Hyper and hypoglycemia have been reported in patients treated concomitantly with quinolones and antidiabetic agents. Careful monitoring of blood glucose is recommended.

              • clarithromycin

                clarithromycin increases levels of tolazamide by plasma protein binding competition. Use Caution/Monitor. Risk of hypoglycemia.

              • clotrimazole

                clotrimazole increases levels of tolazamide by decreasing metabolism. Use Caution/Monitor.

              • clozapine

                clozapine, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • cyclosporine

                tolazamide, cyclosporine. unknown mechanism. Use Caution/Monitor. Cyclosporine may decrease the effects of sulfonylureas. Sulfonylureas may increase the effects of cyclosporine.

              • dapagliflozin

                tolazamide, dapagliflozin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with dapagliflozin.

              • darunavir

                darunavir, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Darunavir may increase or decrease levels of tolazamide. Use alternatives if available. Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

              • diclofenac

                diclofenac increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • diflunisal

                diflunisal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • disopyramide

                disopyramide increases effects of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • dulaglutide

                dulaglutide, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • empagliflozin

                empagliflozin, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with SGLT2 inhibitors.

              • enalapril

                enalapril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • ertugliflozin

                ertugliflozin, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Consider a lower dose of insulin or insulin secretagogue to avoid hypoglycemia when coadministered with ertugliflozin.

              • etodolac

                etodolac increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • exenatide injectable solution

                exenatide injectable solution, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypoglycemia when exenatide is used in combination with agents that induce hypoglycemia. Consider lowering dose of sulfonylureas to reduce risk of hypoglycemia. .

              • exenatide injectable suspension

                exenatide injectable suspension, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypoglycemia when exenatide is used in combination with agents that induce hypoglycemia. Consider lowering dose of sulfonylureas to reduce risk of hypoglycemia.

              • fenofibrate

                fenofibrate increases effects of tolazamide by plasma protein binding competition. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

              • fenofibrate micronized

                fenofibrate micronized increases effects of tolazamide by plasma protein binding competition. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

              • fenofibric acid

                fenofibric acid increases effects of tolazamide by plasma protein binding competition. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

              • fenoprofen

                fenoprofen increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • fleroxacin

                fleroxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • fluconazole

                fluconazole increases levels of tolazamide by decreasing metabolism. Use Caution/Monitor.

              • fluoxetine

                fluoxetine increases effects of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • flurbiprofen

                flurbiprofen increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • fosamprenavir

                fosamprenavir, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Fosamprenavir may increase or decrease levels of tolazamide. Use alternatives if available. Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

              • fosinopril

                fosinopril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • gemfibrozil

                gemfibrozil increases effects of tolazamide by plasma protein binding competition. Use Caution/Monitor. Hypoglycemia; increased risk in hypoalbuminemia.

              • gemifloxacin

                gemifloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • ibuprofen

                ibuprofen increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • ibuprofen IV

                ibuprofen IV increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • iloperidone

                iloperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • imidapril

                imidapril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • indomethacin

                indomethacin increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • insulin aspart

                tolazamide, insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin aspart protamine/insulin aspart

                tolazamide, insulin aspart protamine/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin degludec

                tolazamide, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin degludec/insulin aspart

                tolazamide, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin detemir

                tolazamide, insulin detemir. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin glargine

                tolazamide, insulin glargine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin glulisine

                tolazamide, insulin glulisine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin inhaled

                tolazamide, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin isophane human/insulin regular human

                tolazamide, insulin isophane human/insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin lispro

                tolazamide, insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin lispro protamine/insulin lispro

                tolazamide, insulin lispro protamine/insulin lispro. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin NPH

                tolazamide, insulin NPH. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • insulin regular human

                tolazamide, insulin regular human. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Antidiabetic agents are often used in combination; dosage adjustments may be required when initiating or discontinuing antidiabetic agents.

              • isocarboxazid

                isocarboxazid increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.

              • ketoconazole

                ketoconazole increases levels of tolazamide by decreasing metabolism. Use Caution/Monitor.

              • ketoprofen

                ketoprofen increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • ketorolac

                ketorolac increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • ketorolac intranasal

                ketorolac intranasal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • ketotifen, ophthalmic

                ketotifen, ophthalmic, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Combination may result in thrombocytopenia (rare). Monitor CBC.

              • levofloxacin

                levofloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • linagliptin

                tolazamide, linagliptin. Other (see comment). Use Caution/Monitor. Comment: When linagliptin is used in combination with sulfonylureas, a lower dose of the sulfonylurea may be required to reduce risk of hypoglycemia.

              • linezolid

                linezolid increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.

              • liraglutide

                liraglutide, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serious hypoglycemia may occur when insulin secretagogues and GLP-1 agonists are concurrently administered. Consider lowering the dose of insulin secretagogue to reduce the risk of hypoglycemia. .

              • lisinopril

                lisinopril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • lixisenatide

                lixisenatide, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Risk of hypoglycemia increased when coadministered with sulfonylureas. Sulfonylurea dosage reduction may be required.

              • lopinavir

                lopinavir, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Lopinavir may increase or decrease levels of tolazamide. Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

              • lornoxicam

                lornoxicam increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • lurasidone

                lurasidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • marijuana

                marijuana decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor.

              • mecasermin

                mecasermin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Additive hypoglycemic effects.

              • meclofenamate

                meclofenamate increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • mefenamic acid

                mefenamic acid increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • meloxicam

                meloxicam increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • methyltestosterone

                methyltestosterone increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. It is important to monitor all patients with type 2 diabetes on antidiabetic agents receiving androgens for changes in glycemic control. Potential for hypoglycemia.

              • metreleptin

                tolazamide, metreleptin. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration of metreleptin with insulin and/or insulin secretagogues (eg, sulfonylureas, meglitinide derivatives) may increase risk for hypoglycemia; may require lower dose of insulin or insulin secretagogue.

              • miconazole vaginal

                miconazole vaginal increases levels of tolazamide by decreasing metabolism. Use Caution/Monitor.

              • moexipril

                moexipril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • moxifloxacin

                moxifloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • nabumetone

                nabumetone increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • nadolol

                nadolol decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • naproxen

                naproxen increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • ofloxacin

                ofloxacin increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia. Gatifloxacin is most likely to produce dysglycemia; moxifloxacin is least likely.

              • olanzapine

                olanzapine, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • opuntia ficus indica

                opuntia ficus indica increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • oxaprozin

                oxaprozin increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • paliperidone

                paliperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • parecoxib

                parecoxib increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • perindopril

                perindopril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • phenelzine

                phenelzine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.

              • pindolol

                pindolol decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • piroxicam

                piroxicam increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • posaconazole

                posaconazole increases levels of tolazamide by decreasing metabolism. Use Caution/Monitor.

              • probenecid

                probenecid increases levels of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • propranolol

                propranolol decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • quetiapine

                quetiapine, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • quinapril

                quinapril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • ramipril

                ramipril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • rifabutin

                rifabutin decreases levels of tolazamide by increasing metabolism. Use Caution/Monitor.

              • rifampin

                rifampin decreases levels of tolazamide by increasing metabolism. Use Caution/Monitor.

              • rifapentine

                rifapentine decreases levels of tolazamide by increasing metabolism. Use Caution/Monitor.

              • risperidone

                risperidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              • ritonavir

                ritonavir, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Ritonavir may increase or decrease levels of tolazamide. Reports of hyperglycemia due to insulin resistance with protease inhibitors. .

              • salicylates (non-asa)

                salicylates (non-asa) increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • salsalate

                salsalate increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • selegiline

                selegiline increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Serum glucose should be monitored closely when MAOIs are added to any regimen containing antidiabetic medications. Hypoglycemic effects may be increased.

              • selegiline transdermal

                selegiline transdermal increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.

              • semaglutide

                semaglutide, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of insulin secretagogues with GLP-1 agonists may increase hypoglycemia risk. Lowering the insulin secretagogue dose may reduce hypoglycemia risk. .

              • shark cartilage

                shark cartilage increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor. Theoretical interaction.

              • somapacitan

                somapacitan decreases effects of tolazamide by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Growth hormone products may decrease insulin sensitivity, particularly at higher doses. Antidiabetic agents may require dose adjustment after initiating somapacitan. .

              • sulfadiazine

                sulfadiazine increases levels of tolazamide by plasma protein binding competition. Use Caution/Monitor.

              • sulfamethoxazole

                sulfamethoxazole increases levels of tolazamide by plasma protein binding competition. Use Caution/Monitor.

              • sulfamethoxypyridazine

                sulfamethoxypyridazine increases effects of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • sulfasalazine

                sulfasalazine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • sulfisoxazole

                sulfisoxazole increases levels of tolazamide by plasma protein binding competition. Use Caution/Monitor.

              • sulindac

                sulindac increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • timolol

                timolol decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • tolfenamic acid

                tolfenamic acid increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • tolmetin

                tolmetin increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.

              • trandolapril

                trandolapril increases effects of tolazamide by pharmacodynamic synergism. Use Caution/Monitor.

              • tranylcypromine

                tranylcypromine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor.

              • triamcinolone acetonide injectable suspension

                triamcinolone acetonide injectable suspension decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Corticosteroids may diminish hypoglycemic effect of antidiabetic agents. Monitor blood glucose levels carefully.

              • voriconazole

                voriconazole increases levels of tolazamide by decreasing metabolism. Use Caution/Monitor.

              • xipamide

                xipamide decreases levels of tolazamide by increasing renal clearance. Use Caution/Monitor.

              • ziprasidone

                ziprasidone, tolazamide. Other (see comment). Use Caution/Monitor. Comment: Atypical antipsychotics have been associated with hyperglycemia that may alter blood glucose control; monitor glucose levels closely.

              Minor (86)

              • agrimony

                agrimony increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • American ginseng

                American ginseng increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • amitriptyline

                amitriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • amoxapine

                amoxapine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • anamu

                anamu increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.

              • aspirin

                aspirin increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • aspirin rectal

                aspirin rectal increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • balsalazide

                balsalazide increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • bendroflumethiazide

                bendroflumethiazide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • budesonide

                budesonide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • chloramphenicol

                chloramphenicol increases levels of tolazamide by decreasing metabolism. Minor/Significance Unknown.

              • chlorothiazide

                chlorothiazide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • chlorthalidone

                chlorthalidone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • choline magnesium trisalicylate

                choline magnesium trisalicylate increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • chromium

                chromium increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • clomipramine

                clomipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • clonidine

                clonidine decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.

                clonidine, tolazamide. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production.

              • coenzyme Q10

                tolazamide decreases levels of coenzyme Q10 by unspecified interaction mechanism. Minor/Significance Unknown.

              • cornsilk

                cornsilk increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

              • cortisone

                cortisone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • cyclopenthiazide

                cyclopenthiazide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • damiana

                damiana decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

              • danazol

                danazol increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • deflazacort

                deflazacort decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • desipramine

                desipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • devil's claw

                devil's claw increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • dexamethasone

                dexamethasone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • diflunisal

                diflunisal increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • doxepin

                doxepin increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • elderberry

                elderberry increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (in vitro research).

              • ethotoin

                tolazamide increases levels of ethotoin by plasma protein binding competition. Minor/Significance Unknown.

              • eucalyptus

                eucalyptus increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Theoretical interaction.

              • fludrocortisone

                fludrocortisone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • fluoxymesterone

                fluoxymesterone increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • fo-ti

                fo-ti increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • forskolin

                forskolin increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Colenol, a compound found in Coleus root, may stimulate insulin release.

              • fosphenytoin

                tolazamide increases levels of fosphenytoin by plasma protein binding competition. Minor/Significance Unknown.

              • gotu kola

                gotu kola increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).

              • guanfacine

                guanfacine decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Diminished symptoms of hypoglycemia.

                guanfacine, tolazamide. Other (see comment). Minor/Significance Unknown. Comment: Decreased symptoms of hypoglycemia. Mechanism: decreased hypoglycemia induced catecholamine production.

              • gymnema

                gymnema increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • horse chestnut seed

                horse chestnut seed increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • hydrochlorothiazide

                hydrochlorothiazide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • hydrocortisone

                hydrocortisone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • imipramine

                imipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • indapamide

                indapamide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • isoniazid

                isoniazid decreases effects of tolazamide by unspecified interaction mechanism. Minor/Significance Unknown.

              • juniper

                juniper increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

              • lofepramine

                lofepramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • lycopus

                lycopus increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (theoretical interaction).

              • maitake

                maitake increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of hypoglycemia (animal research).

              • maprotiline

                maprotiline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • mesalamine

                mesalamine increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • mesterolone

                mesterolone increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • methyclothiazide

                methyclothiazide decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • methylprednisolone

                methylprednisolone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • metolazone

                metolazone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown. Thiazide dosage >50 mg/day may increase blood glucose.

              • nettle

                nettle increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction).

              • nortriptyline

                nortriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • ofloxacin

                ofloxacin, tolazamide. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Potential dysglycemia.

              • orlistat

                orlistat increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • oxandrolone

                oxandrolone increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • oxymetholone

                oxymetholone increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • pegvisomant

                pegvisomant increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • phenytoin

                tolazamide increases levels of phenytoin by plasma protein binding competition. Minor/Significance Unknown.

              • potassium acid phosphate

                potassium acid phosphate increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

              • potassium chloride

                potassium chloride increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

              • potassium citrate

                potassium citrate increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Interaction especially seen in the treatment of hypokalemia.

              • prednisolone

                prednisolone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • prednisone

                prednisone decreases effects of tolazamide by pharmacodynamic antagonism. Minor/Significance Unknown.

              • protriptyline

                protriptyline increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • sage

                sage increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • salicylates (non-asa)

                salicylates (non-asa) increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • salsalate

                salsalate increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • sitagliptin

                sitagliptin, tolazamide. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypoglycemia with combination is unknown.

              • stevia

                stevia increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • sulfasalazine

                sulfasalazine increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

              • tacrolimus

                tolazamide increases levels of tacrolimus by unknown mechanism. Minor/Significance Unknown.

              • testosterone

                testosterone increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • testosterone buccal system

                testosterone buccal system increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • testosterone topical

                testosterone topical increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • tongkat ali

                tongkat ali increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypoglycemia.

              • trazodone

                trazodone increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • trimipramine

                trimipramine increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • vanadium

                vanadium increases effects of tolazamide by pharmacodynamic synergism. Minor/Significance Unknown.

              • willow bark

                willow bark increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.

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              Adverse Effects

              Frequency Not Defined

              Hypoglycemia

              Dermatologic reactions

              Heartburn

              Dizziness

              Vertigo

              Anorexia

              Constipation

              Nausea/vomiting

              Cholestatic jaundice and hepatitis may occur rarely which may progress to liver failure

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              Warnings

              Contraindications

              Hypersensitivity, sulfa allergy

              Type I diabetes, diabetic ketoacidosis

              Cautions

              Patients with hypoglycemia, stress due to infection, fever, trauma, or surgery

              May cause loss of glycemic control due to secondary failure

              First generation sulfonylurea

              Intermediate acting agent

              Tolazamide demonstrates weak diuretic effect

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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: not known if crosses into breast milk, avoid

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Initial effect is to increase beta-cell insulin secretion

              May also decrease rate of hepatic glucose production, increases insulin receptor sensitivity, and increases number of insulin receptors

              Pharmacokinetics

              Half-Life: 7 hr

              Duration: 14-24 hr

              Onset: 20 minutes

              Protein binding: 94%

              Peak hypoglycemic effect: 4-6 hr

              Metabolism: Hepatic to less active metabolites

              Metabolites: Inactive metabolites

              Excretion: Urine (85%); feces (7%)

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              Images

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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              Code Definition
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.