An 80-year-old woman with type 2 diabetes and eGFR of 22 mL/min/1.73 m² is found unresponsive at home. Capillary glucose is 31 mg/dL, and she remains hypoglycaemic despite repeated glucose boluses over 12 hours. She had been taking two tablets each morning for years. Which drug most likely caused this prolonged hypoglycaemia?
- A Gliclazide
- B Vildagliptin
- C Glibenclamide ✓
- D Repaglinide
Correct answer: C. Glibenclamide
Explanation
Glibenclamide has a half-life of several hours but its active metabolites are excreted renally and it accumulates strongly in renal failure, producing profound and prolonged hypoglycaemia in the elderly. It is generally avoided when eGFR falls below 30 mL/min/1.73 m². Gliclazide is preferred in renal impairment among sulfonylureas used in India. Repaglinide is short acting with biliary elimination and is considered relatively safe in advanced CKD, and vildagliptin does not cause refractory hypoglycaemia as monotherapy.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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