Gunaratne Keith, Austin Emily, Wu Peter E
Department of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.
BMC Res Notes. 2018 May 21;11(1):331. doi: 10.1186/s13104-018-3404-8.
Sulfonylureas are widely used for type 2 diabetes mellitus, but these medications carry a risk of hypoglycemia. Drug-drug interactions that inhibit sulfonylurea metabolism and thus increase systemic exposure can cause unintentional sulfonylurea toxicity.
A 56-year-old man presented with severe, recurrent hypoglycemia. He had a history of type 2 diabetes mellitus and was taking the sulfonylurea gliclazide with no prior episodes of hypoglycemia. The onset of his hypoglycemia occurred within days after starting voriconazole and subsequently fluconazole for a fungal pneumonia. Unintentional sulfonylurea toxicity developed due to an adverse drug-drug interaction between gliclazide and these antifungals. Azole antifungals inhibit the metabolism of sulfonylureas resulting in increased systemic exposure and consequent toxicity. After the diagnosis of sulfonylurea toxicity was recognized, the patient was treated initially with dextrose and then administered octreotide to prevent recurrent hypoglycemia. He was successfully managed, his hypoglycemic episodes resolved, and his medications were adjusted to avoid any further adverse interactions.
Adverse drug-drug interactions continue to pose challenges to clinicians. Both individual vigilance and system wide strategies are needed to prevent and mitigate consequences. This case highlights an important drug-drug interaction and reviews the presentation, management and antidotal therapy of sulfonylurea toxicity.
磺脲类药物广泛用于2型糖尿病的治疗，但这些药物存在低血糖风险。抑制磺脲类药物代谢从而增加全身暴露量的药物相互作用可导致意外的磺脲类药物中毒。
一名56岁男性出现严重的复发性低血糖。他有2型糖尿病病史，正在服用磺脲类药物格列齐特，之前没有发生过低血糖。在开始使用伏立康唑治疗真菌性肺炎，随后又使用氟康唑后，他在数天内出现了低血糖。由于格列齐特与这些抗真菌药物之间的不良药物相互作用，导致了意外的磺脲类药物中毒。唑类抗真菌药物抑制磺脲类药物的代谢，导致全身暴露量增加，进而产生毒性。在确诊为磺脲类药物中毒后，患者最初接受了葡萄糖治疗，然后使用了奥曲肽以预防复发性低血糖。他得到了成功的治疗，低血糖发作得到缓解，并且调整了用药以避免任何进一步的不良相互作用。
不良药物相互作用继续给临床医生带来挑战。需要个人的警惕性和全系统的策略来预防和减轻后果。本病例突出了一种重要的药物相互作用，并回顾了磺脲类药物中毒的表现、管理和解毒治疗。
