Related Experiment Video
Updated: Jun 13, 2026
07:30
Homogeneous Time-resolved Förster Resonance Energy Transfer-based Assay for Detection of Insulin Secretion
Published on: May 10, 2018
Interaction between voriconazole and glimepiride
1Department of Clinical Pharmacology, Nizam's Institute of Medical Sciences, Hyderabad, India.
Journal of Postgraduate Medicine
|April 16, 2010
Summary
Voriconazole, an antifungal, can interact with glimepiride, a diabetes medication, causing dangerously low blood sugar (hypoglycemia). This drug interaction requires careful monitoring in patients taking both medications.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Internal Medicine
Background:
- Voriconazole is a widely used triazole antifungal agent for invasive fungal infections, particularly in immunocompromised patients.
- Voriconazole is a potent inhibitor of the CYP2C9 enzyme, leading to numerous potential drug interactions.
- Drug interactions involving voriconazole can stem from its pharmacokinetic profile and genetic variations in CYP2C9 activity.
Observation:
- A case report details a significant drug-drug interaction between voriconazole and glimepiride, an oral hypoglycemic agent.
- The interaction resulted in a prolonged and persistent episode of hypoglycemia lasting for 48 hours in the patient.
- Diagnosis was established by observing the temporal relationship between voriconazole administration and the onset of hypoglycemic symptoms.
Findings:
- Withdrawal of voriconazole and glimepiride led to the patient's stabilization.
- This case highlights a specific pharmacokinetic interaction between voriconazole and glimepiride.
- The interaction underscores the potential for severe adverse events even with standard therapeutic doses.
Implications:
- Given the frequent co-prescription of voriconazole, clinicians must exercise extreme caution.
- Increased awareness, a high index of suspicion for adverse drug reactions, and continuous patient monitoring are crucial.
- Vigilance for both expected and unexpected drug interactions is essential when prescribing voriconazole, even with other medications at normal doses.
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...
01:26Oral 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...
01:17Oral Hypoglycemic Agents: Sulfonylureas
Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide (Glucotrol),...
01:26Pharmacokinetics: Drug–Food and Drug–Viral Interactions
A drug interaction occurs when the concurrent use of another drug, food, or an external substance alters the pharmacological activity of a drug. This interaction can modify the action of the original drug, affecting its effectiveness and safety.Drug–food interactions are significant as they impact drug absorption, metabolism, and excretion. For example, grapefruit juice is a well-known disruptor of drug metabolism. It inhibits the cytochrome P450 3A4 enzyme, crucial for the metabolism of many...
01:25Pharmacokinetics: Drug–Drug Interactions
Drug interactions occur when the pharmacological effect of one drug is altered by another substance, either enhancing or diminishing its activity. The drug whose activity is altered is known as the object drug, and the substance causing the alteration is called the agent drug or the precipitant. The net effects of these interactions are mostly undesirable, leading to decreased effectiveness or increased adverse effects. In rare cases, interactions can be beneficial, such as the enhanced...
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...