Hypoglycemia associated with high doses of sertraline and sulphonylurea compound in a noninsulin-dependent diabetes mellitus patient.
Unlike other selective serotonin reuptake inhibitors (SSRIs), sertraline has linear pharmacokinetics so that increases in dose lead to proportional increases in drug concentration. The half-life of sertraline is about 26 h so that it reaches a steady state in one week, according to the product monograph. Hypoglycemia associated with sertraline and coadministration of oral hypoglycemics belonging to the sulphonylurea derivatives has rarely been reported. A patient with schizoaffective disorder with non-insulin-dependent diabetes mellitus (NIDDM) treated with sertraline, risperidone and glyburide who developed hypoglycemia is presented. The article highlights that inhibition of P450 enzymes can be affected by several different factors. Interactions are possible whenever a patient concomitantly receives two drugs that bind to the same P450 system Greater inhibition was likely induced at doses higher than those recommended. This process was reversed within 10 days of discontinuing the sertraline. Good glycemic control followed discontinuation of psychotropic drugs and the oral hypoglycemic agent. Knowledge of the individual P450 enzymes is important in the metabolism of individual drugs, together with an understanding of the patient's drug metabolizing ability. These factors may lead to more appropriate prescribing and further research into specific P450 enzymes responsible for metabolism of particular drugs, which remains unclear.
Takhar
J
J
London Psychiatric Hospital, Ontario. j.takhar@julian.u.w.o.ca
Williamson
P
P
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D004347:Drug Interactions; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000150:complications; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy; D020280:Sertraline / Q000008:administration & dosage / Q000009:adverse effects*; D013453:Sulfonylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*
D018687:Antidepressive Agents, Second-Generation; D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D020280:Sertraline