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Severe hypoglycemia in users of sulfonylurea antidiabetic agents and antihyperlipidemics
Author(s) -
Leonard CE,
Bilker WB,
Brensinger CM,
Han X,
Flory JH,
Flockhart DA,
Gagne JJ,
Cardillo S,
Hennessy S
Publication year - 2016
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.297
Subject(s) - sulfonylurea , fibrate , medicine , glipizide , hypoglycemia , gemfibrozil , glimepiride , hazard ratio , endocrinology , fenofibrate , population , metformin , pharmacology , confidence interval , statin , insulin , cholesterol , environmental health
Drug–drug interactions causing severe hypoglycemia due to antidiabetic drugs is a major clinical and public health problem. We assessed whether sulfonylurea use with a statin or fibrate was associated with severe hypoglycemia. We conducted cohort studies of users of glyburide, glipizide, and glimepiride plus a statin or fibrate within a Medicaid population. The outcome was a validated, diagnosis‐based algorithm for severe hypoglycemia. Among 592,872 persons newly exposed to a sulfonylurea+antihyperlipidemic, the incidence of severe hypoglycemia was 5.8/100 person‐years. Adjusted hazard ratios (HRs) for sulfonylurea+statins were consistent with no association. Most overall HRs for sulfonylurea+fibrate were elevated, with sulfonylurea‐specific adjusted HRs as large as 1.50 (95% confidence interval (CI): 1.24–1.81) for glyburide+gemfibrozil, 1.37 (95% CI: 1.11–1.69) for glipizide+gemfibrozil, and 1.63 (95% CI: 1.29–2.06) for glimepiride+fenofibrate. Concomitant therapy with a sulfonylurea and fibrate is associated with an often delayed increased rate of severe hypoglycemia.