Korean J Clin Pharm.  2018 Sep;28(3):188-193. 10.24304/kjcp.2018.28.3.188.

Concurrent Use of Sulfonylureas and Antimicrobials of the Elderly in Korea: A Potential Risk of Hypoglycemia

• Lee S
• Ock M
• Kim H

• KMID: 2438544
• DOI: http://doi.org/10.24304/kjcp.2018.28.3.188

Abstract

BACKGROUND
Previous studies have noted that the simultaneous use of sulfonylureas and antimicrobials, which is common, could increase the risk of hypoglycemia. In particular, an age of 65 years or older is a known risk factor for sulfonylurea-related hypoglycemia in hospitalized patients. Therefore, we performed this study to determine the potential risk of hypoglycemia from the concurrent use of antimicrobials and sulfonylureas.
METHODS
We performed a cross-sectional study on the National Health Insurance Service-National Sample Cohort from 2013. The eligibility criteria included patients of 65 years of age or older taking a sulfonylurea with 25 different antimicrobials. Different risk ratings of severity in drug-drug interactions (potential DDIs), level X, D, or C in Lexi-Interactâ„¢online, and contraindicated, major, or moderate severity level in Micromedex® were included. SAS version 9.4 was used for data analysis.
RESULTS
A total of 6,006 elderly patients with 25,613 prescriptions were included. The largest age group was 70 to 74 (32.7%), and 39.7% of patients were men. The mean number of prescriptions was 4.3 per patient. The most frequently used antimicrobials were levofloxacin (6,583, 25.7%), ofloxacin (6,549, 25.6%), fluconazole (4,678, 18.0%), and ciprofloxacin (2,551, 9.8%). Among sulfonylureas, glimepiride was prescribed most frequently, followed by gliclazide, glibenclamide, and glipizide.
CONCLUSION
Of the antimicrobials with a high potential of hypoglycemia, levofloxacin, ofloxacin, fluconazole, and ciprofloxacin were used frequently. Thus, the monitoring of clinically relevant interactions is required for patients concurrently administered sulfonylureas and antimicrobials.

Keyword

Sulfonylurea compounds; anti-infective agents; hypoglycemia; drug interactions

MeSH Terms

Aged*
Anti-Infective Agents
Ciprofloxacin
Cohort Studies
Cross-Sectional Studies
Drug Interactions
Fluconazole
Gliclazide
Glipizide
Glyburide
Humans
Hypoglycemia*
Korea*
Levofloxacin
Male
National Health Programs
Ofloxacin
Prescriptions
Risk Factors
Statistics as Topic
Sulfonylurea Compounds
Anti-Infective Agents
Ciprofloxacin
Fluconazole
Gliclazide
Glipizide
Glyburide
Ofloxacin
Sulfonylurea Compounds