Increased risk of hypoglycemia from enalapril plus ranitidine with glibenclamide: A clinical case

A 67-year-old man was admitted to hospital with fever, dyspnea, cough, and hyperglycemia. Amlodipine, digitalis, betamethasone, ceftriaxone, furosemid e, enalapril, glibenclamide, and ranitidine were administered on admission. After about 48 hours on this regimen, the patient's plasma glucose level f ell to 22 mg%. Despite continuous high concentrations of glucose intravenou sly and simultaneous oral administration of glucocorticoid, only after 72 h ours was euglycemia established. Thus, inappropriate administration of oral antidiabetic agents can cause severe hypoglycemia, particularly when other drugs, such as angiotensin-converting enzyme inhibitors and ranitidine, ar e given concomitantly.