Iida H, Morita T, Suzuki E, Iwasawa K, Toyo-oka T, Nakajima T
Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Jpn Heart J. 1999 Jan;40(1):91-6. doi: 10.1536/jhj.40.91.
A 59-year-old man receiving hemodialysis was hospitalized due to severe hypoglycemic attack. The patient had been treated with disopyramide (50 mg/day) because of paroxysmal atrial fibrillation. Hypoglycemia occurred after taking clarithromycin (CAM, 600 mg/day), a macrolide antibiotic. The serum disopyramide concentration reached 8.0 micrograms/ml (23.6 microM) in the presence of CAM, while it was 1.5 micrograms/ml before the addition of CAM. A 75 g oral glucose tolerance test and daily profiles of blood glucose value showed that blood glucose levels were significantly lower in the presence of CAM and disopyramide compared to that in the absence of these drugs. The Turner index in the presence of CAM and disopyramide was significantly higher than that in the absence of these drugs, suggesting that a toxic concentration of disopyramide enhanced insulin secretion, resulting in the induction of hypoglycemic attacks, in which the inhibitory effects of CAM on the hepatic chytochrome P-450 might be involved. QT and QTc intervals were prolonged in the presence of CAM and disopyramide, but torsades de points were not observed in this patient receiving nicorandil (15 mg/day). Thus, it should be taken into account that life-threatening hypoglycemia may result from the interaction between clarithromycin and disopyramide.
一名接受血液透析的59岁男性因严重低血糖发作入院。该患者因阵发性心房颤动一直服用丙吡胺（50毫克/天）。在服用大环内酯类抗生素克拉霉素（CAM，600毫克/天）后发生低血糖。在同时服用CAM的情况下，血清丙吡胺浓度达到8.0微克/毫升（23.6微摩尔），而在添加CAM之前为1.5微克/毫升。75克口服葡萄糖耐量试验和血糖值的每日变化曲线显示，与未使用这些药物时相比，同时使用CAM和丙吡胺时血糖水平显著降低。同时使用CAM和丙吡胺时的特纳指数显著高于未使用这些药物时，这表明丙吡胺的毒性浓度增强了胰岛素分泌，导致低血糖发作，其中可能涉及CAM对肝细胞色素P - 450的抑制作用。在同时使用CAM和丙吡胺的情况下，QT和QTc间期延长，但在服用尼可地尔（15毫克/天）的该患者中未观察到尖端扭转型室速。因此，应考虑到克拉霉素和丙吡胺之间的相互作用可能导致危及生命的低血糖。
