I haven't myself come across the interaction in my own patients, but it is
very important in that it brings up the whole issue of drug interactions
and contraindications.
I suspect (no evidence based data as I do not believe anyone has actually
looked at it..) that the anti-prostaglandin activity of the NSAID would
have stabilised and enhanced the endogenous activity of the pancreas. It is
very likely that there might have been sub-clinical pancreatitis.
Pharmacists and pharmacologists (bless their hearts) are quick to blame
some simplistic direct drug-drug interaction, for example NSAID binding
albumin/carrier proteins etc. Often the causes are more complex and have to
be highly subject to biovariability. Drug-drug interactions (lilke warfarin
+ sulphonamides) are easy and are entirely predictanble. The difficult ones
are unpredictable because of significant clinical biovariability determined
by co-existing disease states.
Indeed I believe the behaviour of drugs in the presence of disease is a
whole science of its own which has been seriously neglected.
What about a Department of Pharmacopathology ??
Jon Wilcox
Auckland
New Zealand
----------
> From: Sam Macfie <[log in to unmask]>
> To: [log in to unmask]
> Subject: NSAIDs and diabetes
> Date: Thursday, 19 September 1996 10:48
>
> Just as an interesting snippet; a insulin-taking diabetic patient of
> mine in his early 50s has been unstable with violent peaks and
> troughs. He was recently put on diclofenac for a painful neck and
> immediately had to reduce insulin by 50% and with a steady glucose
> level. He was delighted. The data sheet for voltarol indicates that
> this can occur as well as hyperglycaemia but it is the first time I
> have come across it and in such a dramatic way. Any other such
> experiences?
> ------------------------------
> Dr Sam Macfie, Haxby, York, UK
> ------------------------------
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