Related Experiment Video
Updated: Jul 5, 2026
12:08
Improving IV Insulin Administration in a Community Hospital
Published on: June 11, 2012
Severe hypoglycemia from clarithromycin-repaglinide drug interaction
Mogher Khamaisi1, Eran Leitersdorf
1Department of Medicine and the Diabetes Research Unit, Hadassah Hospital, Ein Kerem, and Hebrew University Medical School, Jerusalem, Israel. murir@hadassah.org.il
Pharmacotherapy
|May 2, 2008
Summary
A potential drug interaction between clarithromycin and repaglinide can cause severe hypoglycemia in type 2 diabetes patients. Close blood glucose monitoring is advised when these medications are co-prescribed, especially in elderly individuals.
Area of Science:
- Pharmacology
- Endocrinology
- Nephrology
Background:
- Repaglinide is an oral hypoglycemic agent used for type 2 diabetes mellitus.
- Drug interactions with repaglinide can lead to hypoglycemia.
- Elderly patients with end-stage renal disease (ESRD) are particularly vulnerable to adverse drug events.
Observation:
- A case of severe hypoglycemia was observed in an 80-year-old male with well-controlled type 2 diabetes and ESRD.
- The patient was concurrently taking repaglinide and was initiated on clarithromycin for Helicobacter pylori infection.
- Hypoglycemic episodes occurred within 48 hours of starting clarithromycin, resolving upon discontinuation of repaglinide.
Findings:
- This case suggests a potential drug interaction between clarithromycin and repaglinide.
- Clarithromycin may potentiate the hypoglycemic effect of repaglinide.
- The interaction appears significant, leading to severe and recurrent hypoglycemia requiring medical intervention.
Implications:
- Clinicians should exercise caution when prescribing clarithromycin to patients with type 2 diabetes who are taking repaglinide.
- Close monitoring of blood glucose levels is crucial in elderly patients, particularly those with renal impairment, during co-administration.
- This interaction may necessitate repaglinide dosage adjustments or alternative antidiabetic therapies.
Related Concept Videos
01:06Oral Hypoglycemic Agents: Glinides
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
01:26Hypoglycemia
Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...
01:23Dipeptidyl Peptidase 4 Inhibitors
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a significant...
01:15Hypoglycemia and Glucagon
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood glucose levels...
01:19Oral Hypoglycemic Agents: α-Glucosidase Inhibitors
α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are typically...
Acarbose and miglitol are typically...