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Hypoglycemia associated with high
doses of sertraline and sulphonylurea compound in a noninsulin-dependent
diabetes mellitus patient.
Takhar J, Williamson
London Psychiatric Hospital, Ontario.
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.
PMID: 10465860 [PubMed - indexed for