Case Presentation of a 45 Years Old Woman with Hypoglycemia and Bleeding A case with hypoglycemia and bleeding
Iranian Journal of Pharmaceutical Sciences,
Vol. 1 No. 3 (2005),
1 July 2005
,
Page 183-188
https://doi.org/10.22037/ijps.v1.39511
Abstract
Apatient was admitted to the hospital because of epistaxis, ecchymoses and gum bleeding with INR of 5.5. This patient had a known case of diabetes mellitus type II, 5 years ago. The last dose of glibenclamide for managing signs and symptoms of diabetes mellitus was 20 mg/day. Her medical history also showed that last month she was diagnosed with atrial fibrillation with normal left ventricular ejection fraction (LVEF> 45%) and was placed on warfarin (5 mg) and propranolol (80 mg) daily, which resulted in resolution of atrial fibrilation, a pulse rate of 80 bps and INR of 3 (target INR=2-3). An objective causality assessment indicated the increased effect of warfarin and as a result bleeding could best be explained by drug-drug interaction because there are no other factors such as pathological evidences (e.g. thyroid disease, hepatic disorders) to prove it otherwise. This case is the third report of drug interaction between warfarin and glibenclamide, therefore, this is an interesting and educational case.
In view of our experience in the present case, it should be stressed that close monitoring of coagulation capacity is necessary in co-administration of warfarin and other drugs which can affect pharmacokinetic and pharmacodynamic of warfarin.
- Drug interation
- Glibenclamide
- Warfarin
How to Cite
References
[2] Levin MN, Raskob G, Lanctefeld S, Kearon C. Hemorrhagic complications of anticoagulant. Chest 2001; 119: 108s-21s.
[3] Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors know at the start of outpatient therapy. Am J Med 1989; 87: 144-52.
[4] Schulman S. Care of patients receiving longterm anticoagulant therapy. N Engl J Med 2003; 349: 657-83.
[5] Warwick JA, Corral RJ. Serious interaction between warfarin and terbinafine. Br Med J 1998; 316: 440.
[6] Konishi H, Eguchi Y, Fujii M, Saotome T, Sasaki T. Unusual hypersensitivity to warfarin in a critically ill patient. J Clin Pharm and Ther 2004; 29: 485-90.
[7] White HD, Gresh BG, Opie LH. Antithrombotic agents: platelet inhibitors, anticoagulants, and fibrinolytics. In: Opie LH, Gresh BG, (editors). Drugs for the heart. 5th ed. Philadelphia: Saunders, 2001; pp. 273-322.
[8] Kodakimble MA, Carlisle BA. Diabetes mellitus. In: Kodakimble MA, Yuong LY, (editors). Applied therapeutics. The clinical use of drugs. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2000; pp.48-1-9.
[9] Kim KA, Park JY. Inhibitory effect of glyburide on human cytochrome P450 isoforms in human liver microsomes. Drug Metab Disp 2003; 31: 1090-2.
[10] Takahashi H, Wilkinson GR, Caraco Y, Muszkat M. Population differences in S-warfarin metabolism between CYP2C9 genotype-matched Caucasian and Japanese patients. Clin Pharmacol Ther 2003; 73: 253-63.
[11] Takahashi H, Kashma T, Nomizo Y, Muramoto N. Metabolism of warfarin enantiomers in Japanese patients with heart disease having different CYP- 2C9 and CYP2C19 genotypes. Clin Pharmacol 1998; 63:519-28.
[12] www.medicinescomplete.com/mc/stockley/ current/noframes/x15-0849.htm.
[13] Rendell M. The role of sulfonylureas in the management of type 2 diabetes melliuts. Drugs 2004; 64: 1338-58.
[14] Plum A, Muller LK, Jansen JA. The effect of selected drugs on the in vitro protein binding of repaglinde in human plasma. Arzenimittel forschung 1983; 33: 1533-7.
[15] Sanads CD, Chan ES, Welty TE. Revisiting the significance of warfarin protein binding displacement interactions. Ann Pharmacother 2002; 36:1640-4.
[16] Gibaldi M, Koup JR. Pharmacokintic concepts of drug binding, apparent volume of distribution and clearance. Europ J Clin Pharmacol 1981; 20:299-305.
[17] Cryer PE. Hypoglycemia. In: Kasper D, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (editors). Harrisons principles of internal medicine. 16th ed. New York: McGraw- Hill, 2005; pp. 2180-5.
[18] Burge MR, Schmitz-fiorentino K, Fischette C. A prospective trial of risk factors for sulfonylurea–induced hypoglycemia in type 2 diabetes mellitus. JAMA 1998; 279: 137-43.
[19] Marker JC, Cryer PE, Clutter WE. Attenuated glucose recovery form hypoglycemia in the elderly. Diabetes 1992; 41: 671-8.
[20] Matyka K, Evans M, Lomas J. Altered hierarchy of protective responses against severe hypoglycemia in normal aging in healthy men. Diabetes Care 1997; 157:1681-6.
[21] Drugs facts and comparisons. Cardiovascular agents. 59 th ed. Washington: Facts and Comparisons, 2005; p. 505.
[22] Groop LC. Sulfonylureas in NIDDM. Diabetes Care 1992; 15: 737-48.
[23] Landry MJ, Toescu V, Kendall MJ. The cardioprotective role of b-blockers in patients with diabetes mellitus. J Clin Ther 2002; 27: 233-42.
[24] Wells PS, Holbrook AM, Crowther NR, Hirsh J. Interaction of warfarin with drugs and food. Ann Intern Med 1994; 121: 676-83.
[25] Blaufarb I, Pfeifer TM, Frishman WH. b- Blockers: Drug interactions of clinical significance. Drug Saf 1995;13:359-70.
[26] Otagiri M, Maruyama T, Imai T, Suenaga A, Imamura Y. Acomparative study of the interaction of warfarin with human a1-acid glycoprotein and human albumin. J Pharm Pharmacol 1987; 39: 416-20.
[27] Bauer LA. Applied clinical pharmacokinetics. NewYork: McGraw- Hill, 2001; pp. 3-26.
[28] Zhou HH, Adedoyin A, Wilkinson GR. Differences in plasma binding of drugs between Caucasians and Chinese subjects. Clin Pharmacol Ther 1990; 48: 10-7.
[29] Hermann LS, Scherseten B, Bitzen PO. Therapeutic comparison of metformin and sulfonyurea alone or in vinous combinations: a double blind controlled study. Diabetes Care 1994; 17: 1100-9.
[30] Riddle M. Combining sulfonylurea and other oral agents. Am J Med 2000; 108 (suppl 69): 15S-22S.
[31] Luna B, Feinglos MN. Oral agents in the development of type 2 diabetes mellitus. Am Family Phys 2001; 63:1747-60.
- Abstract Viewed: 80 times
- IJPS_Volume 1_Issue 3_Pages 183-188 Downloaded: 30 times