Naproxen Glibenclamide

A 64-year-old man with type II diabetes, hypertension, and bilateral renal artery stenosis presented with confusion and dysarthria related to profound hypoglycemia (2.2 mmol/1). He was taking naproxen 500 mg bd, ramipril 2.5 mg/day, glibenclamide 2.5 mg bd, metformin 850 mg bd, a thiazide diuretic, terazosin, ranitidine, paracetamol, and codeine. His plasma creatinine concentration, previously 185 pmol/1, was 362 pmol/1 and it fell to 210 imol/l after the withdrawal of ramipril and naproxen. 

The authors discussed the possible role of renal insufficiency, resulting from co-prescription of naproxen and ramipril in the presence of volume depletion, which may have increased the risk of hypoglycemia related to glibenclamide plus metformin. 

A 58-year-old woman with longstanding type 2 diabetes taking metformin 500 mg twiee daily developed serious acute renal failure and lactic acidosis one month after starting rofecoxib. She made a full recovery. Rofecoxib could have precipitated acute renal failure, which would lead to the accumulation of metformin, and metformin-associated lactic acidosis. For a case of hypoglycaemia attributed to ramipril and naproxen-induced renal failure in a patient taking metformin and glibenclamide, see Glibenclamide, below. 

Naproxen. A case of severe hypoglycaemia in a diabetic patient was attributed to the accumulation of glibenclamide and metformin due to deterioration in renal function caused by the concurrent use of ramipril and naproxen. ... 

A 51-ycar-old man who had been taking Iovastatin 40 mg daily for 5 years developed muscle aches and fever one day after finishing a 5-day course of azithromycin 250 mg daily. His creatine phosphokinase levels were elevated and he was diagnosed as having rhabdomyolysis. This patient was also taking colestyramine, diltiazem, doxazosin, glibenclamide (glyburide), thyroid , allopurinol, naproxen, prednisone, loratadine and inhaled beclometasone. ... 

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