Ranitidine Glibenclamide

The bioslurry treatment successfully removed several of the PhC to non-detectable levels after 26 days three histamine H2-receptor antagonists (ranitidine, famotidine, cimetidine), two (1-blockers (atenolol, sotalol), one barbiturate (butalbital) and one antidiabetic compound (glibenclamide). The elimination of the sulfonamide antibiotics sulfapyridine (100%), sulfamethazine (91.0%) and... 

A 67-year-old man using glucocorticoids for asthma, ranitidine 300 mg/day, and enalapril 5 mg/day developed a low blood glucose (1.2 mmol/ 1) within 48 hours of starting to take glibenclamide 5-10 mg/day. 

A 64-year-old man, who used, amongst other drugs, glibenclamide 2.5 mg/day and metformin 850 mg bd, lost consciousness after a week of dwindling appetite and loose stools. His blood glucose was 2.2 mmol/1. He had renal impairment (creatinine 362 pmol/1). He also used ranitidine and ramipril 2.5 mg/day, which could have contributed to both the hypoglycemic effect and renal insufficiency. 

Parlapiano C, Paoletti V, Campana E, Giovanniello T, Pantone P. Increased risk of hypoglycemia from enalapril plus ranitidine with glibenclamide a clinical case. Adv Ther 1999 16 130-2. 

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. 

A 66-year-old man with schizophrenia took zuclopenthixol 10 mg tds for 18 days and developed a mild leukopenia (2.9 x 109/1) and thrombocytopenia (109 x 109/1). He was asymptomatic, with no evidence of infection or a bleeding tendency. Zuclopenthixol was withdrawn, without any change in the rest of his drug therapy (glibenclamide 5 mg tds, biperiden 2 mg bd, oxazepam 10 mg tds, dipyridamole 75 mg tds, and ranitidine 150 mg/day). The leukocyte and platelet counts rose over the next 5 days. 

On the whole cimetidine and ranitidine do not appear to significantly alter diabetic control with sulphonylureas, although cases of adverse effects have been seen when glibenclamide was given with ranitidine, and when gliclazide or glipizide were given with cimetidine. 

Kubacka RT, Antal EJ, Juhl RP The paradoxical effect of cimetidine and ranitidine on glibenclamide pharmacdcineticsandpharmaccH namics BrJ Clin PhamuK ol( 9 23, 743-51. 

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