چكيده لاتين :
Apatient was admitted to the hospital because of epistaxis, ecchymoses and gum
bleeding with INR of 5.5. This patient had a known case of diabetes mellitus type
II, 5 years ago. The last dose of glibenclamide for managing signs and symptoms
of diabetes mellitus was 20 mg/day. Her medical history also showed that last
month she was diagnosed with atrial fibrillation with normal left ventricular ejection
fraction (LVEF> 45%) and was placed on warfarin (5 mg) and propranolol (80 mg)
daily, which resulted in resolution of atrial fibrilation, a pulse rate of 80 bps and INR
of 3 (target INR=2-3). An objective causality assessment indicated the increased effect
of warfarin and as a result bleeding could best be explained by drug-drug interaction
because there are no other factors such as pathological evidences (e.g. thyroid
disease, hepatic disorders) to prove it otherwise. This case is the third report of drug
interaction between warfarin and glibenclamide, therefore, this is an interesting and
educational case.
In view of our experience in the present case, it should be stressed that close
monitoring of coagulation capacity is necessary in co-administration of warfarin and
other drugs which can affect pharmacokinetic and pharmacodynamic of warfarin.
