Combining Warfarin and Certain Diabetes Drugs Increases Risk of Hospitalization
A drug interaction between the blood thinner warfarin and the diabetes drugs glipizide and glimepiride could be associated with significant risk of hospitalization related to hypoglycemia, especially in patients starting warfarin.
To examine the results of interaction between warfarin and the 2 sulfonylureas, researchers conducted a retrospective cohort analysis of claims from a 20% random sample of Medicare beneficiaries 65 years old and older. The study included 465,918 participants with diabetes who filled prescriptions for glipizide or glimepiride between 2006 and 2011, 71,895 of which also filled prescriptions for warfarin.
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Overall, 2111 participants visited the emergency department or were admitted to the hospital for hypoglycemia, 78 of who had multiple events. Adjusted odds ratios for hospital admission for hypoglycemia were 1.22 compared to those taking only glipizide or glimepiride. Interaction between the diabetes drugs and warfarin was also associated with increased risk of emergency department visit for fall related fractures and altered mental status.
Risk of adverse effects was strongest in patients between 65 and 74 years old and in those beginning warfarin for the first time. No increased risk was observed in patients taking warfarin with other diabetes drugs, or in those taking statins with glipizide or glimepiride. This, researchers wrote, suggests a drug-drug interaction.
“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,” researchers concluded.
“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.”
—Michael Potts
References:
- Romley JA, Gong C, Jena AB, et al. Association between use of warfarin with common sulfonylureas and serious hypoglycemic events: retrospective cohort analysis. BMJ. 2015;351:h6223.
- University of Southern California. Blood thinner, antidiabetic drug mix increase hospitalizations [press release]. December 8, 2015. https://pressroom.usc.edu/blood-thinner-antidiabetic-drug-mix-increase-hospitalizations/.