Severe hypoglycaemia from repaglinide-brotizolam drug interaction: A case report and literature review

摘要

Drug-induced hypoglycaemia in elderly patients with Type 2 diabetes mellitus is a major clinical concern. Repaglinide is a short-acting anti-diabetic drug of the meglitinide analogue class that lowers blood glucose concentration by stimulating insulin release from pancreatic functioning beta-cells. In vitro studies suggest that cytochrome P450 3A4 and 2C8 contribute to its oxidative biotransformation [1]. Two drugs have been reported to interact with repaglinide in patients with Type 2 diabetes and to induce hypoglycaemia [2,3]. Here, we describe a patient with diabetes who presented with severe hypoglycaemia as a result of the metabolic interaction of repaglinide and brotizolam. Brotizolam is a short-acting benzodiazepine indicated as first-line therapy for sleep difficulties. This drug is widely metabolized by cytochrome P450 3A4 in the liver and has an intermediate half-life of approximately 5 h [4].