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Sulfonylurea, warfarin combination may increase serious hypoglycemic events
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The use of warfarin with the sulfonylureas glipizide and glimepiride may increase the risk for serious hypoglycemic events among older patients with diabetes.
According to the researchers, clinicians should pay close attention to those patients just starting warfarin.
Anne Peters, MD, professor at the Keck School of Medicine at the University of Southern California and director of the USC Westside Center for Diabetes, and colleagues evaluated data from pharmacy and medical claims from a 20% random sample of Medicare fee for service on 465,918 adults aged 65 years or older with diabetes who filled a prescription for glipizide or glimepiride between 2006 and 2011. Fifteen percent of participants also filled a prescription for warfarin. Researchers sought to determine ED visits or hospital admissions with a primary diagnosis of hypoglycemia among the population.
Compared with person-quarters without warfarin use, hospital admission or ED visits for hypoglycemia were more common in person-quarters with concurrent sulfonylurea and warfarin use (adjusted OR = 1.22, 95% CI, 1.05-1.42). A higher rate of hospital admissions for hypoglycemia was found with concurrent use of sulfonylurea and warfarin (adjusted OR = 1.45; 95% CI, 1.06-1.97).
Hospital admissions or ED visit rates for hypoglycemia were higher in person-quarters with first-time use of warfarin and in participants aged 65 to 74 years.
“The take-home message is simply that an interaction can occur that has clinical significance, so providers need to be aware in order to prevent a low blood sugar issue from occurring,” Peters said in a press release. “Sometimes this means having the patient monitor their blood sugar levels more often. There are many ways to deal with the issue if one is forewarned.”
However, there is no need for pharmacists to change patient instructions, according to study researcher Bradley Williams, PharmD, of the USC School of Pharmacy and USC Davis School of Gerontology.
“What it does require is for pharmacists and other clinicians to be more vigilant when a sulfonylurea is added to a regimen that includes warfarin, as well as when a patient who is taking both has a change in their medical status,” he said in the release. “I think additional research into the potential interactions between medications for diabetes and warfarin, as well as other drugs that affect blood clotting, is warranted because of the potential consequences of excessive bleeding.” – by Amber Cox
Disclosure: Peters and Williams report no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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