Glibenclamide-associated hypoglycaemia: a report on 57 cases

Area of Science:

• Pharmacology
• Geriatrics
• Clinical Toxicology

Background:

• Glibenclamide, a first-generation sulfonylurea, is widely prescribed for type 2 diabetes.
• Hypoglycemia is a known adverse effect of sulfonylureas, but severe cases associated with glibenclamide require further investigation.
• Elderly patients are particularly vulnerable to adverse drug reactions.

Purpose of the Study:

• To investigate the characteristics and risk factors of glibenclamide-associated hypoglycemia.
• To analyze the severity, duration, and outcomes of these hypoglycemic events.
• To compare patient demographics and glibenclamide prescription data.

Main Methods:

• Retrospective review of 57 cases of glibenclamide-associated hypoglycemia reported to the Swedish Adverse Drug Reactions Advisory Committee.
• Analysis of sales and prescription data for glibenclamide.
• Comparison with a random sample of glibenclamide-prescribed patients.

Main Results:

• The study identified 57 cases of glibenclamide-associated hypoglycemia.
• Patients experiencing hypoglycemia were older (median age 75) compared to the general glibenclamide-prescribed population (median age 70).
• Common presentations included coma or disturbed consciousness, with a median minimum blood glucose of 1.3 mmol/l. Protracted hypoglycemia (12-72 hours) occurred in 24 patients, and 10 patients died, even with low glibenclamide doses (2.5-5 mg/day).

Conclusions:

• Glibenclamide can cause serious, protracted, and fatal hypoglycemic events, similar to other first-generation sulfonylureas.
• Advanced age, history of stroke, cardiac disorders, impaired renal function, and other factors contribute to severe hypoglycemia.
• Healthcare providers should exercise caution when prescribing glibenclamide, especially to elderly patients and those with risk factors.