Helicobacter pylori Eradication Therapy-induced Severe Hypoglycemia in a Hemodialysis Patient with Type 2 Diabetes Mellitus.

A 48-year-old man with type 2 diabetes mellitus experienced recurrent severe hypoglycemia during hemodialysis induction and received Helicobacter pylori eradication therapy with vonoprazan, amoxicillin, and clarithromycin. He was on repaglinide, which he continued to take even after the discontinuation of empagliflozin. The patient's lowest glucose level was 39 mg/dL. As hypoglycemia developed immediately after the initiation of eradication therapy, clarithromycin-repaglinide interaction via cytochrome P450 3A4 inhibition was suspected. The hypoglycemia resolved after switching to teneligliptin. This case highlights a clinically important but under-recognized risk of severe hypoglycemia associated with vonoprazan-based Helicobacter pylori eradication therapy in patients receiving insulin secretagogues, especially those with advanced renal failure.