Interaction between voriconazole and glimepiride

Voriconazole, a triazole antifungal, is gaining popularity in the treatment of invasive fungal infections, mostly in the immuno-compromised patients. Voriconazole, a CYP2C9 inhibitor, has many potential drug interactions. Its interactions are both due to its pharmacokinetic properties and the genetic polymorphism of CYP2C9 enzymes. Here is a case report of one such drug-drug interaction between voriconazole and glimepiride, an oral hypoglycemic agent, which led to prolonged and persistent hypoglycemia for 48 h. It was diagnosed by the temporal association of the occurrence of symptoms with voriconazole intake. The patient stabilized on withdrawal of the responsible drugs. Due to the high incidence of co-prescribing voriconazole with other drugs, caution has to be exercised while prescribing it. Clinicians' awareness, a high index of suspicion and constant monitoring for adverse drug reactions, expected or unexpected drug interactions has to be emphasized, even if the co-prescribed drugs are in normal therapeutic doses.