KACHI memorial hospital, Toyohashi, Aichi prefecture, Japan.
Daru. 2020 Jun;28(1):419-421. doi: 10.1007/s40199-020-00333-0. Epub 2020 Feb 26.
Sodium glucose cotransporter 2 (SGLT2) inhibitors are hypoglycemic agents characterized by a weight loss effect. This effect is likely to increase blood levels of other drugs. Reason for the report: SGLT2 inhibitor-induced weight reduction could bring unexpected side effects of other drugs whose blood concentrations are affected by body weight. However, this interaction between SGLT2 inhibitor and other drugs via weight loss effect has not been reported so far.
I describe the case of a 67-year-old male with bipolar I disorder who was treated with valproate. He was diagnosed with type 2 diabetes mellitus, started treatment with empagliflozin, and his body weight decreased gradually. Two months after he started empagliflozin, he developed hand tremor which was one of the symptoms of valproate intoxication, and his tremor was improved by dose reduction of valproate. It seemed that this symptom was brought mainly by weight loss effect of empagliflozin. These observations suggest the existence of a detour where blood concentrations of some drugs are increased by weight loss due to SGLT2 inhibitors. Clinicians need to be aware of the blood levels of drugs in patients with type 2 diabetes mellitus after starting SGLT2 inhibitors. Graphical abstract.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂是一类具有降低血糖作用的药物，其特点是可引起体重减轻。这种作用可能会增加其他药物的血药浓度。报告原因：SGLT2 抑制剂引起的体重减轻可能会带来其他药物的意外副作用，这些药物的血药浓度受体重影响。然而，到目前为止，还没有关于 SGLT2 抑制剂通过体重减轻效应与其他药物之间的这种相互作用的报道。
我描述了一位 67 岁男性的病例，该患者患有 I 型双相情感障碍，曾接受丙戊酸钠治疗。他被诊断患有 2 型糖尿病，开始服用恩格列净治疗，体重逐渐下降。开始服用恩格列净两个月后，他出现了震颤，这是丙戊酸钠中毒的症状之一，通过减少丙戊酸钠的剂量，震颤得到改善。这种症状似乎主要是由恩格列净的体重减轻作用引起的。这些观察结果表明，由于 SGLT2 抑制剂的存在，存在一条血药浓度增加的旁路，某些药物的血药浓度会因体重减轻而增加。临床医生需要注意 2 型糖尿病患者开始使用 SGLT2 抑制剂后药物的血药浓度。
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