73-year-old with anemia and mild thrombocytopenia for five months. Workup showed
ID: 127579 • Letter: 7
Question
73-year-old with anemia and mild thrombocytopenia for five months. Workup showed no evidence of blood loss. He is quite fatigued and has lost weight. No fever, jaundice, pruritus, dark-colored urine, bleeding or melena. He recently started taking Hyzaar, but he has had no other recent medication changes.
PAST MEDICAL HISTORY:
1. Anemia and mild thrombocytopenia, both recently diagnosed.
2. History of atrial fibrillation.
3. Type 2 diabetes.
4. Hyperlipidemia.
5. Congestive heart failure.
MEDICATIONS:
1. Glyburide 5 mg twice daily.
2. Lipitor 40 mg daily.
3. Digoxin 0.15 mg daily.
4. Hyzaar daily
SOCIAL HISTORY:
He is a retired anesthesiologist, married, 3 children. Former pipe smoker. Drank 2 to 3 glasses of wine daily, but abstinent recently.
FAMILY HISTORY:
A grandmother had type 2 diabetes. Father had Parkinson disease and Mother died of old age at 94. A sister has asthma, CHF and obesity.
REVIEW OF SYSTEMS:
He feels tired and weak. He has chronic right shoulder rotator cuff pain. No GU symptoms. He has had anorexia and a 10-pound weight loss over the last couple of months. He has shortness of breath with light activity. He was treated for pneumonia in fall 2003. He has atrial fibrillation, but no chest pain. No neurologic symptoms, rashes, or emotional problems. Had trouble with blood sugar control recently, metformin was discontinued.
PHYSICAL EXAMINATION:
Somewhat obese. His sclera are anicteric. No palpable cervical, supraclavicular, axillary or inguinal adenopathy. The heart rhythm is irregularly irregular. The lungs are clear to auscultation. Abdomen is soft, nontender and nondistended. Spleen is not palpable. The liver is palpable 1 to 2 fingerbreadths below the costal margin. The extremities have trace edema. Neurologic exam shows no focal deficits.
Answer the following question:
Are there any medication interactions you are concerned about?
Explanation / Answer
The drug interaction between glyburide and Lipitor (Atorvastatin calcium):
Statins are a group of drugs that decrease cholesterol synthesis in the liver. These drugs inhibit the enzyme “HMG Co-A reductase” that is essential for cholesterol synthesis. Statins are generally prescribed to reduce the blood LDL (low-density lipoproteins) cholesterol levels, which reduces the risk of coronary heart disease (CHD).
Eg: Lovostatin, simvastatin, atorvastatin.
Atorvastatin is metabolized by the hepatic CYP 3A4 and 3A5, while it is having inhibitory effects on CYP 2C9, 3A4, and 2D6. The glyburide is an anti-diabetic drug, which is metabolized by hepatic CYP3A4 enzymes. So, Co-administration of Lipitor and glyburide increases the plasma drug concentration of glyburide by up to 20%, which increases the risk of hypoglycemia.
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