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Glyburide-ciprofloxacin interaction with resistant hypoglycemia
Raymond J Roberge1, Richard Kaplan1, Robert Frank1
1From the Department of Emergency Medicine, Western Pennsylvania Hospital,(*) and the Affiliated Residency in Emergency Medicine, University of Pittsburgh School of Medicine,(‡) Pittsburgh, PA.
Annals of Emergency Medicine
|August 5, 2000
Summary
Ciprofloxacin may increase glyburide levels, causing hypoglycemia. This case highlights a potential drug interaction between the antibiotic ciprofloxacin and the diabetes medication glyburide, necessitating clinical awareness.
Area of Science:
- Pharmacology
- Drug Metabolism
- Clinical Medicine
Background:
- Glyburide, a sulfonylurea, is metabolized by hepatic P-450 enzymes.
- Ciprofloxacin, a quinolone antibiotic, is a known P-450 inhibitor.
- Existing literature presents conflicting data on quinolone-glyburide interactions.
Observation:
- A patient on long-term glyburide therapy developed hypoglycemia.
- The patient's serum glyburide level was elevated after one week of ciprofloxacin use.
Findings:
- This case demonstrates a significant drug interaction between ciprofloxacin and glyburide.
- Ciprofloxacin appears to inhibit the hepatic metabolism of glyburide, leading to increased drug levels.
Implications:
- Clinicians must consider this potential interaction when prescribing ciprofloxacin to patients on glyburide.
- Monitoring glyburide levels and blood glucose is crucial in such cases.
- This finding warrants further investigation into the pharmacokinetic interactions between quinolones and sulfonylureas.