Helicobacter pylori Eradication Therapy-induced Severe Hypoglycemia in a Hemodialysis Patient with Type 2 Diabetes Mellitus.
Miyo Kim, Akihiro Katayama, Eisaku Morimoto et al.
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Case in brief
A 48-year-old man with type 2 diabetes receiving hemodialysis developed recurrent severe hypoglycemia while taking repaglinide during Helicobacter pylori eradication therapy with vonoprazan, amoxicillin, and clarithromycin. His glucose reached a nadir of 39 mg/dL. Because the episodes began immediately after therapy was started, a clarithromycin–repaglinide interaction through CYP3A4 inhibition was suspected. Hypoglycemia resolved after repaglinide was replaced with teneligliptin.
What made this case unusual
Severe hypoglycemia emerged during vonoprazan-based eradication therapy in a hemodialysis patient who continued repaglinide; the authors suspected an interaction between clarithromycin and repaglinide.
Diagnostic / clinical pearl
In advanced renal failure, new severe hypoglycemia during clarithromycin-containing H. pylori therapy should prompt review of concomitant insulin secretagogues, including possible CYP3A4-mediated interaction with repaglinide.