Ramipril Metformin

Betamethasone + Gentamicin S-Amlodipine + Losartan S-Amlodipine + Atenolol Pioglitazone + Glimeperide Glimeperide + Metformin Rosiglitazone + Glimeperide Tramadol + Paracetamol Ramipril + s(-) Amlodipine Olanzapine + Fluoxetine Ciprofloxacin + Ornidazole Quinapril + HCTZ (Hydrochlorothiazide)... 

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. 

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. 

You are a supplementary prescriber working in a diabetes clinic when John Stephens comes in to see you. He is still overweight despite being on the maximum dose of metformin and gliclazide. His HbAlc is 9.0% and on examination he has neuropathy developing in his feet. He is also on ramipril 10 mg, simvastatin 40 mg and aspirin 75 mg daily. His blood pressure was 130/80 mmHg and his total cholesterol was 4.0 mmol/L (reading from three months ago). There is no microalbuminuria present. 

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. ... 

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