Abstract
A 72-year-old woman was admitted to our hospital because she felt weakness of the first and second fin-gers of her left hand. She had non-insulin dependent diabetes mellitus and was managed with oral antidiabetic drugs (glibenclamide and voglibose). A diffusion weighted image of brain MRI on the day revealed a spotty high intensity lesion in her right frontal subcortical area. Transesophageal echocardiography and RI venography demonstrated patent foramen ovale and deep venous thrombosis. She was diagnosed as having paradoxical brain embolism and was started on oral warfarin (3 mg daily) on 12 July 2002 to prevent subsequent stroke. On the day, she suffered hypoglycemic attacks in the evening, and despite glucose transfusion, hypoglycemia occurred frequently. Before starting warfarin, she had never experienced hypoglycemia. After glibenclamide administration was stopped, she no longer had hypoglycemic attacks. Although interactions between glibenclamide and warfarin have been recognized, only a few reports have described hypoglycemia caused by the interaction of glibenclamide and warfarin. Attention should be paid to this problem in the case of patients who need both warfarin and glibenclamide.
