Comparative risk of severe hypoglycemia among concomitant users of thiazolidinedione antidiabetic agents and antihyperlipidemics

Highlights • Concomitant thiazolidinedione + fibrate use was associated with a ∼1.5- to 2.5-fold increased risk of severe hypoglycemia. • This increased risk generally manifested after the first month of concomitant use. • Severe hypoglycemia occurs in some patients receiving a thiazolidinedione, even without concomitant exposure to insulin or a sulfonylurea. • The apparent drug interaction between thiazolidinediones and fibrates is an underappreciated cause of severe hypoglycemia. • Clinicians should be attuned to both immediate- and delayed-onset hypoglycemia in their patients treated concomitantly with thiazolidinediones and fibrates.