Clinicopharmacological evaluation of drug interaction between Rifampicin and gliburide in Tuberculosis patients with Type II diabetes.

Abstract

In our community Diabetes Mellitus and pulmonary Tuberculosis are still very common. The % of Pulmonary Tuberculosis among diabetic patients is nearly 27% by radiological diagnosis (377J IMA vol 100NO.6 june 2002). The % of diabetes among pulmonary tuberculosis patients is 6.5%. Both diseases are chronic and co-exist not commonly. It is said that if tuberculosis is uncontrolled inspite of meticulous anti TB treatment of tuberculosis patients suspect latent diabetes. When both diseases coexist they are mutually aggravating. If they are simultaneously treated effectively the effect is good. Unfortunately TB requires polypharmacy. Some of the recent anti TB drugs like Rifampicin have enzyme inducing capacity producing a low blood level concentration of certain drugs like glibenclamide ( sulphonylurea) with which it interacts. In maturity onset diabetic (NIDDM)patients with TB taking glibenclamide for the control of diabetes and Rifampicin containing regimens., simultaneously for TB it was found that the requirements of the oral hypoglycaemic agents are increased to control the diabetes 1 . It was proved that Rifampicin by inducing the cytchrome P450 enzymes in the liver interacts with glibenclamide resulting in low blood level concentration of glibenclamide with less stimulation of Beta cells of pancreas with lowered endogenous insulin production, with little hypoglycaemic effect resulting in uncontrolled hyperglycaemia. This was an established fact. So to evaluate and assess the drug interaction of Rifampicin with glibenclamide in Type II diabetes with PT patients, this study was under taken. Similar study was not done previously in this hospital.