Which of the following interactions increases the risk of hypoglycemia when taking sulfonylureas?

• A. Ethanol (disulfiram)
• B. NSAIDs, sulfonamide antibiotics, cimetidine
• C. Beta blockers
• D. All of the above

Answer: (D)

Sulfonylureas push the pancreas to release more insulin, lowering blood glucose no matter what the current level is. Any factor that increases the drug’s effect or reduces the body’s ability to counteract low glucose can raise the risk of hypoglycemia.

Ethanol can cause low blood sugar by suppressing the liver’s production of glucose. When someone drinking or with recent alcohol intake uses a sulfonylurea, the combined glucose-lowering effects can be stronger, increasing hypoglycemia risk.

NSAIDs, sulfonamide antibiotics, and cimetidine can raise sulfonylurea levels in the blood—either by competing for metabolism or by displacing the drug from protein binding. Higher levels mean a longer and stronger insulin-release effect, which makes hypoglycemia more likely.

Beta blockers can mask the warning signs of low blood sugar (like trembling or paleness) and can also blunt the body’s glucose-raising responses, such as glycogenolysis and gluconeogenesis. This makes hypoglycemia harder to detect and harder to correct promptly, increasing danger when using sulfonylureas.

So all of these categories can increase the risk, which is why all of the above is the best answer.