Key result
Warfarin combined with glibenclamide triggers severe bleeding with an INR of 5.5 and hypoglycemia.
Why the study?
Drug interaction between warfarin and glibenclamide causing increased warfarin effect and bleeding is rarely reported and requires clinical awareness.
Does the co-administration of warfarin, glibenclamide, and propranolol cause adverse drug-drug interactions such as bleeding and hypoglycemia in a patient with diabetes and atrial fibrillation?
Case Report (n=1)
No
Does the co-administration of warfarin, glibenclamide, and propranolol cause adverse drug-drug interactions such as bleeding and hypoglycemia in a patient with diabetes and atrial fibrillation?
Co-administration of warfarin and glibenclamide can lead to clinically significant drug-drug interactions resulting in bleeding and hypoglycemia, necessitating close monitoring of coagulation and blood glucose.
Apatient was admitted to the hospital because of epistaxis, ecchymoses and gum bleeding with INR of 5.5. This patient had a known case of diabetes mellitus type II, 5 years ago. The last dose of glibenclamide for managing signs and symptoms of diabetes mellitus was 20 mg/day. Her medical history also showed that last month she was diagnosed with atrial fibrillation with normal left ventricular ejection fraction (LVEF> 45%) and was placed on warfarin (5 mg) and propranolol (80 mg) daily, which resulted in resolution of atrial fibrilation, a pulse rate of 80 bps and INR of 3 (target INR=2-3). An objective causality assessment indicated the increased effect of warfarin and as a result bleeding could best be explained by drug-drug interaction because there are no other factors such as pathological evidences (e.g. thyroid disease, hepatic disorders) to prove it otherwise. This case is the third report of drug interaction between warfarin and glibenclamide, therefore, this is an interesting and educational case.In view of our experience in the present case, it should be stressed that close monitoring of coagulation capacity is necessary in co-administration of warfarin and other drugs which can affect pharmacokinetic and pharmacodynamic of warfarin.
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Namazi et al. (2005) conducted a case report in Drug interaction causing bleeding and hypoglycemia (n=1). Co-administration of warfarin and glibenclamide was evaluated on Bleeding and hypoglycemia. Co-administration of warfarin and glibenclamide resulted in severe bleeding with an INR of 5.5 and hypoglycemia due to a drug-drug interaction.
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