Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report

Abstract Background Bucolome is a non-steroidal anti-inflammatory drug and uricosuric agent, currently used only in Japan. It is known to induce drug interactions by inhibiting cytochrome P450 (CYP) 2C9. It is often used to enhance the anticoagulant effect of warfarin by utilizing its drug interacti...

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Autores principales:	Hiroki Tateishi, Daisuke Miyazu, Miho Kurinami, Ichiro Ieiri, Masaaki Hirakawa, Hiroyuki Watanabe
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Bucolome Glimepiride Hypoglycemia Drug–drug interaction CYP2C9 Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/d6642925a14244d5a973711891674add
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spelling	oai:doaj.org-article:d6642925a14244d5a973711891674add2021-11-07T12:02:10ZHypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report10.1186/s40780-021-00221-y2055-0294https://doaj.org/article/d6642925a14244d5a973711891674add2021-11-01T00:00:00Zhttps://doi.org/10.1186/s40780-021-00221-yhttps://doaj.org/toc/2055-0294Abstract Background Bucolome is a non-steroidal anti-inflammatory drug and uricosuric agent, currently used only in Japan. It is known to induce drug interactions by inhibiting cytochrome P450 (CYP) 2C9. It is often used to enhance the anticoagulant effect of warfarin by utilizing its drug interactions. There are only a few reports on drug interactions of bucolome and the mechanism remain poorly understood. Case presentation An 81-year-old woman with a history of type 2 diabetes mellitus was taking glimepiride 2 mg/day and voglibose 0.6 mg/day. After hospitalization, the patient underwent surgical aortic valve replacement surgery (day 0). Glimepiride and voglibose were resumed on the second postoperative day (day 2), and warfarin was started to prevent thromboembolism. Since the prothrombin time-international normalized ratio on day 9 was low at 1.24, 300 mg/day of bucolome was added to enhance the effect of warfarin. A gradual decrease in blood glucose levels was observed from the day after bucolome administration was initiated. Hypoglycemia in the 56–57 mg/dL range occurred before lunch and dinner on the 6th day (day 14) of bucolome administration, due to which voglibose was discontinued. Hypoglycemia below 70 mg/dL was not observed thereafter, and the general condition of the patient was stable. Conclusions Based on the clinical course and literature review, we believe that hypoglycemia in the present case was due to a drug interaction, caused by inhibition of CYP2C9 by bucolome and competitive inhibition of CYP2C9 by warfarin, which affected the pharmacokinetics of glimepiride. The possibility of hypoglycemia due to drug interactions should be considered by physicians, when bucolome is included to enhance the effect of warfarin, in patients taking glimepiride.Hiroki TateishiDaisuke MiyazuMiho KurinamiIchiro IeiriMasaaki HirakawaHiroyuki WatanabeBMCarticleBucolomeGlimepirideHypoglycemiaDrug–drug interactionCYP2C9Therapeutics. PharmacologyRM1-950Pharmacy and materia medicaRS1-441ENJournal of Pharmaceutical Health Care and Sciences, Vol 7, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Bucolome Glimepiride Hypoglycemia Drug–drug interaction CYP2C9 Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441
spellingShingle	Bucolome Glimepiride Hypoglycemia Drug–drug interaction CYP2C9 Therapeutics. Pharmacology RM1-950 Pharmacy and materia medica RS1-441 Hiroki Tateishi Daisuke Miyazu Miho Kurinami Ichiro Ieiri Masaaki Hirakawa Hiroyuki Watanabe Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report
description	Abstract Background Bucolome is a non-steroidal anti-inflammatory drug and uricosuric agent, currently used only in Japan. It is known to induce drug interactions by inhibiting cytochrome P450 (CYP) 2C9. It is often used to enhance the anticoagulant effect of warfarin by utilizing its drug interactions. There are only a few reports on drug interactions of bucolome and the mechanism remain poorly understood. Case presentation An 81-year-old woman with a history of type 2 diabetes mellitus was taking glimepiride 2 mg/day and voglibose 0.6 mg/day. After hospitalization, the patient underwent surgical aortic valve replacement surgery (day 0). Glimepiride and voglibose were resumed on the second postoperative day (day 2), and warfarin was started to prevent thromboembolism. Since the prothrombin time-international normalized ratio on day 9 was low at 1.24, 300 mg/day of bucolome was added to enhance the effect of warfarin. A gradual decrease in blood glucose levels was observed from the day after bucolome administration was initiated. Hypoglycemia in the 56–57 mg/dL range occurred before lunch and dinner on the 6th day (day 14) of bucolome administration, due to which voglibose was discontinued. Hypoglycemia below 70 mg/dL was not observed thereafter, and the general condition of the patient was stable. Conclusions Based on the clinical course and literature review, we believe that hypoglycemia in the present case was due to a drug interaction, caused by inhibition of CYP2C9 by bucolome and competitive inhibition of CYP2C9 by warfarin, which affected the pharmacokinetics of glimepiride. The possibility of hypoglycemia due to drug interactions should be considered by physicians, when bucolome is included to enhance the effect of warfarin, in patients taking glimepiride.
format	article
author	Hiroki Tateishi Daisuke Miyazu Miho Kurinami Ichiro Ieiri Masaaki Hirakawa Hiroyuki Watanabe
author_facet	Hiroki Tateishi Daisuke Miyazu Miho Kurinami Ichiro Ieiri Masaaki Hirakawa Hiroyuki Watanabe
author_sort	Hiroki Tateishi
title	Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report
title_short	Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report
title_full	Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report
title_fullStr	Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report
title_full_unstemmed	Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report
title_sort	hypoglycemia possibly caused by cyp2c9-mediated drug interaction in combination with bucolome: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/d6642925a14244d5a973711891674add
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Hypoglycemia possibly caused by CYP2C9-mediated drug interaction in combination with bucolome: a case report

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