Drug Interaction Between Sartans and Pyridostigmine With a Focus on Hypoglycaemia: A Critical Review

Abstract

Sartans (angiotensin II receptor blockers, ARBs) and pyridostigmine are frequently prescribed drugs, each with well-established therapeutic roles. ARBs are widely used to manage hypertension, protect the cardiovascular system, and slow the progression of kidney disease, while pyridostigmine remains essential for conditions such as myasthenia gravis and autonomic dysfunction. Emerging evidence suggests that both classes of drugs can independently influence glucose metabolism. This review critically examines the global literature—including hospital case reports, pharmacovigilance signals, experimental studies, and mechanistic data—to evaluate their combined potential to precipitate hypoglycemia. Although no large clinical series directly document such events, mechanistic plausibility and scattered clinical reports highlight the need for caution, particularly in high‑risk patients. We also identify gaps in current knowledge and propose directions for future research.