Glimepiride with Voriconazole Interaction Details
Brand Names Associated with Glimepiride
- Amaryl®
- Avandaryl® (as a combination product containing Glimepiride, Rosiglitazone)
- Duetact® (as a combination product containing Glimepiride, Pioglitazone)
- Glimepiride
Brand Names Associated with Voriconazole
- Vfend®
- Voriconazole
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 14, 2023
Interaction Effect
Increased risk of hypoglycemia
Interaction Summary
Caution is advised when voriconazole is coadministered with glimepiride. One case report documents a severe and persistent hypoglycemic episode temporally associated with the initiation of voriconazole in a patient previously stabilized on glimepiride therapy. Voriconazole is a CYP2C9 inhibitor and CYP2C9 has been shown to be involved in glimepiride metabolism. The manufacturer warns of a potential interaction of glimepiride with inhibitors (eg, fluconazole) and inducers (eg, rifampicin) of CYP2C9 .
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Use glimepiride and voriconazole concomitantly with caution or use a therapeutic alternative. Monitor blood glucose levels closely when voriconazole is added or discontinued during treatment with glimepiride.
Mechanism Of Interaction
Inhibition of the CYP2C9-mediated biotransformation of glimepiride by voriconazole
Literature Reports
A) Severe and persistent hypoglycemia occurred in a patient well-controlled on glimepiride when voriconazole was started as empiric antifungal therapy. In this case report, a 69-year old male patient receiving glimepiride 1 mg daily for the previous 7 months was started on voriconazole 400 mg every 12 hours for 2 doses followed by 200 mg every 12 hr when his myelodysplastic condition progressed to acute myeloid leukemia and he developed febrile neutropenia. Prior to starting on voriconazole, no concerns were noted on baseline testing. On day 2, two hours after taking his first voriconazole 200 mg dose, he suddenly became confused and developed excessive and pressured speech. His blood sugar was found to be 40 mg/dL. Serum electrolytes and liver function tests were normal. An infusion of dextrose 25% immediately stabilized his blood sugars. Two hours later, he was unconscious with a blood sugar of 38 mg/dL. Suspecting a drug interaction, voriconazole and glimepiride were stopped and he was started on an infusion of 5% dextrose. Hourly blood glucose monitoring revealed persistent and prolonged hypoglycemia lasting 48 hr. On day 3, his blood sugar levels stabilized, and voriconazole was restarted. Subcutaneous insulin was substituted for glimepiride and no further episodes of hypoglycemia were reported .
Glimepiride Overview
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Glimepiride is used along with diet and exercise, and sometimes with other medications, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Glimepiride lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently. This medication will only help lower blood sugar in people whose bodies produce insulin naturally. Glimepiride is not used to treat type 1 diabetes (condition in which the body does not produce insulin and, therefore, cannot control the amount of sugar in the blood) or diabetic ketoacidosis (a serious condition that may occur if high blood sugar is not treated).
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Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes.
Voriconazole Overview
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Voriconazole is used in adults and children 2 years of age and older to treat serious fungal infections such as invasive aspergillosis (a fungal infection that begins in the lungs and spreads through the bloodstream to other organs), esophageal candidiasis (a yeast [a type of fungus] infection that may cause white patching in the mouth and throat), and candidemia (a fungal infection in the blood). It is also used to treat certain other fungal infections when other medications will not work for certain patients. Voriconazole is in a class of antifungal medications called triazoles. It works by slowing the growth of the fungi that cause infection.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.