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Singh P, Walia V, Verma PK. Hypoglycemia and anxiolysis mediated by levofloxacin treatment in diabetic rats. J Diabetes Metab Disord 2023; 22:1197-1209. [PMID: 37975146 PMCID: PMC10638278 DOI: 10.1007/s40200-023-01234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/03/2023] [Indexed: 11/19/2023]
Abstract
Purpose The present study was designed to determine the effect of levofloxacin (LVX) treatment on the blood glucose level, insulin sensitivity, anxiety level, nitrite and MDA level of STZ induced diabetic rats. Methods Wistar rats were used in the present study. The rats were made diabetic by the administration of single dose of STZ (45 mg/kg, i.p.) and NAD (50 mg/kg, i.p.). The rats with the blood glucose level greater than 200 mg/dl were considered as diabetic (confirmed at day-3 of STZ-NAD administration). The non-diabetic rats were considered as control and received saline.Diabetic rats received metformin (50 mg/kg, p.o.) and LVX (20, 25, 30 and 35 mg/kg, i.p.) daily for 14 days (starting from the day at which STZ was injected). Following administration on 14th day,the blood sample was collected and the rats were subjected to behavioral assays for the determination of locomotor activity and anxiety level. Plasma was separated and used for the estimation ofnitrite and malondialdehyde (MDA)level. On 15th day OGTT was performed in the overnight fasted rats for the assessment of insulin sensitivity. Results The results obtained suggested that the administration of STZ-NAD induced the hyperglycemia at day-3 of administration. Diabetic rats displayed the significant increase in blood glucose, anxiety related behavior, MDA level while significant decrease in the insulin sensitivity and plasma nitrite level. Daily administration of metformin to the diabetic rats decreased the blood glucose level, increased the time spent at the center of open field, reversed the anxiety related behavior in LDT and EPM, did not affect the plasma nitrite level, decreased the plasma MDA level, decreased the fasting glucose level and AUC in OGTT assay. LVX (30 and 35 mg/kg) treatment significantly decreased the blood glucose level of diabetic rats. LVX (20, 25 and 30 mg/kg) treatment significantly decreased the number of square crossing while LVX (20, 25, 30 and 35) treatment significantly increased the time spent at the center of the field by the diabetic rats. LVX (20 and 35 mg/kg) treatment significantly reversed the STZ induced anxiety in LDT while LVX (20, 30 and 35 mg/kg) treatment significantly reversed the STZ induced anxiety in EPM test. LVX (20, 25 and 35 mg/kg) treatment significantly increased the plasma nitrite level and LVX (20-35 mg/kg) treatment significantly decreased the MDA level of diabetic rats. Further only LVX (35 mg/kg) treatment significantly decreased the fasting glucose level and increased the AUC of diabetic rats. Conclusion In conclusion, STZ-NAD administration increased the blood glucose level, anxiety related behavior, decreased the plasma nitrite and increased the MDA level. LVX administration potentiated the diabetogenic effects of STZ-NAD in rats. Daily administration of LVX decreased the blood glucose level of diabetic rats. LVX administration alleviated the STZ induced anxiety in OFT, LDT and EPM test. LVX administration increased the plasma nitrite level and decreased the lipid peroxidation in diabetic rats. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01234-0.
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Affiliation(s)
- Poonam Singh
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, 124001 Haryana India
| | - Vaibhav Walia
- SGT College of Pharmacy, SGT University, Gurugram, Haryana India
| | - Prabhakar Kumar Verma
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, 124001 Haryana India
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Insulinotropic Potential of Moxifloxacin and Gemifloxacin: An In Vivo Rabbits Model Study Followed by Randomized Phase I Clinical Trial. Antibiotics (Basel) 2022; 11:antibiotics11020148. [PMID: 35203750 PMCID: PMC8868483 DOI: 10.3390/antibiotics11020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Fluoroquinolones (FQs) have been reported to cause dysglycemia in both diabetic and non-diabetic patients. However, diabetic patients are usually on polypharmacy, so we cannot attribute the dysglycemia specifically to FQs. To answer the question as to whether Moxifloxacin and Gemifloxacin influence blood glucose levels and serum insulin levels or otherwise, rabbits were used as experimental animals in an in vivo model followed by a phase I randomized clinical trial in euglycemic healthy volunteers. The effects on the serum insulin and blood glucose levels in the Moxifloxacin and Gemifloxacin treated groups were, respectively, determined on the fifth day in both the in-vivo rabbits model and in the test subjects of the phase I clinical trial. The effects of these drugs were also checked on the histomorphology of the pancreas in the rabbits. The findings of our study suggest that Moxifloxacin and Gemifloxacin significantly (p < 0.05) reduced the blood glucose levels via a subsequent significant shift in the serum insulin levels both in the in vivo animal model and in the test subjects of the phase I clinical trial. No prominent effects on the beta cells histomorphology were noted in this study. Moxifloxacin showed a more significant effect than Gemifloxacin. The insulinotropic effect was comparable to the effect of Glibenclamide. It is concluded that Moxifloxacin and Gemifloxacin have a significant blood glucose lowering effect mediated through insulinotropic action. (Clinical Trials.gov identifier: NCT04692623).
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Falay Gur T, Savas Erdogan S, Erdemir VA, Doğan B. Effect of omalizumab use on glucose homeostasis in non-diabetic patients with chronic urticaria. Cutan Ocul Toxicol 2020; 39:348-353. [PMID: 32885684 DOI: 10.1080/15569527.2020.1818769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE In some diabetic patients receiving omalizumab therapy, blood glucose regulation is impaired. However, the effect of omalizumab on glucose homeostasis in non-diabetic patients remains unknown. METHODS The patients were given subcutaneous omalizumab at a dose of 300 mg every four weeks for the treatment of chronic urticaria in this study. Fasting blood glucose, fasting plasma insulin, total cholesterol, triglyceride, and high-density (HDL) and low-density lipoprotein (LDL) were studied before and at the 12th week of treatment. The homeostatic model assessment for insulin resistance (HOMA-IR) was used to determine insulin resistance. RESULTS Forty of the 45 patients included in the study completed 12 weeks of treatment. While fasting blood glucoses (p = 0.011) and HOMA-IR values (p = 0.027) were significantly increased in the 12th week, the increase in fasting insulin level was not significant (p = 0.07). After treatment, 10 patients developed impaired fasting glucose and 13 developed insulin resistance. CONCLUSION The increase in blood glucose levels may be associated with the paradoxically increase of histamine levels in the blood by omalizumab. If this increase cannot be balanced with insulin, patients may develop impaired glucose tolerance and insulin resistance. Therefore, we suggest that patients using omalizumab should be followed up for glucose homeostasis and insulin resistance.
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Affiliation(s)
- Tugba Falay Gur
- Department of Dermatology, Sultan Abdulhamid Han Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Sevil Savas Erdogan
- Department of Dermatology, Sultan Abdulhamid Han Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Vefa Aslı Erdemir
- Department of Dermatology, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Bilal Doğan
- Department of Dermatology, Sultan Abdulhamid Han Training and Research Hospital, Health Science University, Istanbul, Turkey
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Nagata M, Kimura Y, Ishiwata Y, Takahashi H, Yasuhara M. Clozapine-Induced Acute Hyperglycemia Is Accompanied with Elevated Serum Concentrations of Adrenaline and Glucagon in Rats. Biol Pharm Bull 2018; 41:1286-1290. [DOI: 10.1248/bpb.b18-00195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Masashi Nagata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University (TMDU)
- Department of Pharmacokinetics and Pharmacodynamics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Yuri Kimura
- Department of Pharmacokinetics and Pharmacodynamics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Yasuyoshi Ishiwata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University (TMDU)
| | - Hiromitsu Takahashi
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University (TMDU)
| | - Masato Yasuhara
- Department of Pharmacokinetics and Pharmacodynamics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
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Fang Q, Guo C, Wang Y, Liu Y. The study on interactions between levofloxacin and model proteins by using multi-spectroscopic and molecular docking methods. J Biomol Struct Dyn 2017; 36:2032-2044. [PMID: 28604271 DOI: 10.1080/07391102.2017.1341335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The interactions of levofloxacin (LEV) with lysozyme (LYZ), trypsin and bovine hemoglobin (BHb) were investigated, respectively, by using multi-spectral techniques and molecular docking in vitro. Fluorescence studies showed that LEV quenched LYZ/trypsin fluorescence in a combined quenching ways and BHb fluorescence in a static quenching with binding constants of .14, .51 and .20 × 105 L mol-1 at 298 K, respectively. The thermodynamic parameters demonstrated that hydrophobic forces, hydrogen bonds, and van der Waals forces played the major role in the binding process. The binding distances between LEV and the inner tryptophan residues of LYZ, trypsin, and BHb were calculated to be 4.04, 3.38, and 4.52 nm, respectively. Furthermore, the results of circular dichroism spectra (CD), UV-vis, and three-dimensional fluorescence spectra indicated that the secondary structures of LYZ, trypsin, and BHb were partially changed by LEV with the α-helix percentage of LYZ-LEV system increased while that of BHb-LEV system was decreased, the β-sheet percentage of trypsin-LEV system increased from 41.3 to 42.9%. UV-vis spectral results showed that the binding interactions could cause conformational and some micro-environmental changes of LYZ, trypsin, and BHb. The results of molecular docking revealed that in LYZ and trypsin systems, LEV bound to the active sites residues GLU 35 and ASP 52 of LYZ and trypsin at the active site SER 195, and in BHb system, LEV was located in the central cavity, which was consistent with the results of synchronous fluorescence experiment. Besides, LEV made the activity of LYZ decrease while the activity of trypsin increased.
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Affiliation(s)
- Qing Fang
- a College of Life and Environmental Sciences, Minzu University of China , Beijing 100081 , China
| | - Chenhui Guo
- a College of Life and Environmental Sciences, Minzu University of China , Beijing 100081 , China
| | - Yirun Wang
- a College of Life and Environmental Sciences, Minzu University of China , Beijing 100081 , China
| | - Ying Liu
- a College of Life and Environmental Sciences, Minzu University of China , Beijing 100081 , China.,b Beijing Engineering Research Center of Food Environment and Public Health, Minzu University of China , Beijing 100081 , China
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Nagata M, Nakajima M, Ishiwata Y, Takahashi Y, Takahashi H, Negishi K, Yasuhara M. Mechanism Underlying Induction of Hyperglycemia in Rats by Single Administration of Olanzapine. Biol Pharm Bull 2016; 39:754-61. [DOI: 10.1248/bpb.b15-00842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Masashi Nagata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University
| | - Mayumi Nakajima
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University
- Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Yasuyoshi Ishiwata
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University
| | - Yutaka Takahashi
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University
| | - Hiromitsu Takahashi
- Department of Pharmacy, Medical Hospital, Tokyo Medical and Dental University
| | - Kenichi Negishi
- Faculty of Pharmaceutical Sciences, Tokyo University of Science
| | - Masato Yasuhara
- Department of Pharmacokinetics and Pharmacodynamics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
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Kabbara WK, Ramadan WH, Rahbany P, Al-Natour S. Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia. Ther Clin Risk Manag 2015; 11:639-47. [PMID: 25960658 PMCID: PMC4410896 DOI: 10.2147/tcrm.s81280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged. Objective The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia) in diabetic and nondiabetic patients. Methods A prospective observational study at a teaching hospital in Lebanon was conducted over a 6-month period. A total of 118 patients receiving broad-spectrum fluoroquinolones (levofloxacin, ciprofloxacin, and moxifloxacin) were identified. Patients were mainly recruited from internal medicine floors and intensive care units. Results The final percentage for the appropriate indication, dose, and duration of fluoroquinolone therapy was 93.2%, 74.6%, and 57.6%, respectively. A total of 57.1% of the patients did not receive the appropriate dose adjustment according to their level of renal impairment. In addition, dysglycemia occurred in both diabetic and nondiabetic patients. Dysglycemia was more frequently encountered with ciprofloxacin (50.0%), followed by levofloxacin (42.4%) and moxifloxacin (7.6%). Hyperglycemia was more common than hypoglycemia in all groups. The highest incidence of hyperglycemia occurred with levofloxacin (70.0%), followed by ciprofloxacin (39.0%) and moxifloxacin (33.3%). In contrast, hypoglycemia did not occur in the ciprofloxacin group, but it was more common with moxifloxacin (11.1%) and levofloxacin (6.0%). Conclusion The major clinical interventions for the future will adjust the dose and duration of therapy with commonly prescribed fluoroquinolones. The incidence of hypoglycemia was less common than hyperglycemia.
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Affiliation(s)
- Wissam K Kabbara
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Wijdan H Ramadan
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Peggy Rahbany
- Children's National Medical Center, Washington, DC, USA
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Zhu L, Zhang Y, Yang J, Wang Y, Zhang J, Zhao Y, Dong W. Prediction of the pharmacokinetics and tissue distribution of levofloxacin in humans based on an extrapolated PBPK model. Eur J Drug Metab Pharmacokinet 2015; 41:395-402. [PMID: 25753830 DOI: 10.1007/s13318-015-0271-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/23/2015] [Indexed: 12/27/2022]
Abstract
This study developed a physiologically based pharmacokinetic (PBPK) model in intraabdominally infected rats and extrapolated it to humans to predict the levofloxacin pharmacokinetics and penetration into tissues. Twelve male rats with intraabdominal infections induced by Escherichia coli received a single dose of 50 mg/kg body weight of levofloxacin. Blood plasma was collected at 5, 10, 20, 30, 60, 120, 240, 480 and 1440 min after injection, respectively. A PBPK model was developed in rats and extrapolated to humans using GastroPlus software. The predictions were assessed by comparing predictions and observations. In the plasma concentration-versus-time profile of levofloxacin in rats, C max was 23.570 μg/ml at 5 min after intravenous injection, and t1/2 was 2.38 h. The plasma concentration and kinetics in humans were predicted and validated by the observed data. Levofloxacin penetrated and accumulated with high concentrations in the heart, liver, kidney, spleen, muscle and skin tissues in humans. The predicted tissue-to-plasma concentration ratios in abdominal viscera were between 1.9 and 2.3. When rat plasma concentrations were known, extrapolation of a PBPK model was a method to predict the drug pharmacokinetics and penetration in humans. Levofloxacin had good penetration into the liver, kidney and spleen as well as other tissues in humans. This pathological model extrapolation may provide a reference for the study of antiinfective PK/PD. In our study, levofloxacin penetrated well into abdominal organs. Also ADR monitoring should be implemented when using levofloxacin.
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Affiliation(s)
- Liqin Zhu
- Pharmacy Department, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
| | - Yuan Zhang
- Pharmacy Department, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Jianwei Yang
- Tianjin Medical University, Tianjin, 300070, China
| | | | - Jianlei Zhang
- Pharmacy Department, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Yuanyuan Zhao
- The 153 Central Hospital of the Chinese People's Liberation Army, Henan, 450000, China
| | - Weilin Dong
- Tianjin Medical University, Tianjin, 300070, China
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Ishiwata Y, Takahashi Y, Nagata M, Yasuhara M. Effects of Moxifloxacin on Serum Glucose Concentrations in Rats. Biol Pharm Bull 2013; 36:686-90. [DOI: 10.1248/bpb.b12-00930] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yasuyoshi Ishiwata
- Department of Pharmacy, University Hospital of Medicine, Tokyo Medical and Dental University
| | - Yutaka Takahashi
- Department of Pharmacy, University Hospital of Medicine, Tokyo Medical and Dental University
| | - Masashi Nagata
- Department of Pharmacy, University Hospital of Medicine, Tokyo Medical and Dental University
| | - Masato Yasuhara
- Department of Pharmacy, University Hospital of Medicine, Tokyo Medical and Dental University
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Absi M, Ghareeb H, Khalil A, Ruegg UT. The effect of levofloxacin and moxifloxacin on cardiovascular functions of rats with streptozotocin-induced diabetes. Diab Vasc Dis Res 2013; 10:65-71. [PMID: 22621918 DOI: 10.1177/1479164112445755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Fluoroquinolone antibiotics cause rare, but clinically important, adverse events including hyperglycaemia and hypoglycaemia. The present study focuses on the possible effect of levofloxacin and moxifloxacin on the cardiovascular functions of rats with type I diabetes. Both antibiotics caused bradycardia. Levofloxacin but not moxifloxacin caused hypoglycaemia in diabetic rats and an increase in amplitude of the ST segment revealed by electrocardiogram (ECG) analysis of isolated hearts. In pressurized mesenteric arteries, levofloxacin did not affect the endothelium-derived hyperpolarising factor (EDHF) pathway or its main components, the small-conductance Ca(2+) activated potassium (SK(Ca)) and intermediate-conductance Ca(2+) activated potassium (IK(Ca)) channels. In moxifloxacin-treated rats, an increase in the EDHF response was observed, which was largely attributed to SK(Ca)-activation. In conclusion, levofloxacin and moxifloxacin use appeared to vary but with no evidence of impairment of the cardiovascular function. However, it is still possible that these antibiotics may produce different effects if there are co-morbidities and therefore their use must be with care.
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Affiliation(s)
- Mais Absi
- Pharmacology and Toxicology Department, Aleppo University, Syria.
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K. Suresh K, D. Bhosale S, V. Thulasiram H, J. Kulkarni M. Comparative and chemical proteomic approaches reveal gatifloxacin deregulates enzymes involved in glucose metabolism. J Toxicol Sci 2011; 36:787-96. [DOI: 10.2131/jts.36.787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Kesavan K. Suresh
- Proteomics Facility, Division of Biochemical Sciences, CSIR-National Chemical Laboratory, India
| | - Santosh D. Bhosale
- Proteomics Facility, Division of Biochemical Sciences, CSIR-National Chemical Laboratory, India
| | - Hirekodathakallu V. Thulasiram
- Chemistry Biology Unit, Division of Organic Chemistry, CSIR- National Chemical Laboratory, India
- CSIR-Institute of Genomics and Integrative Biology, India
| | - Mahesh J. Kulkarni
- Proteomics Facility, Division of Biochemical Sciences, CSIR-National Chemical Laboratory, India
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12
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Ishiwata Y, Yasuhara M. Gatifloxacin-induced histamine release and hyperglycemia in rats. Eur J Pharmacol 2010; 645:192-7. [DOI: 10.1016/j.ejphar.2010.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 06/07/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
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NAGAI M, NAGATA S, YAMAGISHI N, SATOH H, FURUHAMA K. Clinicopathological Aspect of Dysglycemia in Naive and Diabetic Rats induced by the Fluoroquinolone Antibacterial Gatifloxacin. J Vet Med Sci 2010; 72:567-73. [DOI: 10.1292/jvms.09-0465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mikiko NAGAI
- Department of Veterinary Basic Medicine, Iwate University
| | - Saori NAGATA
- Department of Veterinary Basic Medicine, Iwate University
| | - Norio YAMAGISHI
- Department of Veterinary Clinical Medicine, Iwate University
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Gibert A, Porta F. Hypoglycemia and Levofloxacin: A Case Report. Clin Infect Dis 2008; 46:1126-7. [DOI: 10.1086/529392] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Singh M, Jacob JJ, Kapoor R, Abraham J. Fatal hypoglycemia with levofloxacin use in an elderly patient in the post-operative period. Langenbecks Arch Surg 2008; 393:235-8. [PMID: 18175142 DOI: 10.1007/s00423-007-0268-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Accepted: 12/14/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Fluoroquinolones are antimicrobial agents with a broad spectrum of activity against gram-positive, gram-negative, and anaerobic organisms. They are widely used in surgical practice and are generally considered safe. Hypoglycemia because of use of levofloxacin is a rarely reported complication. This report of a case of a surgical patient highlights this potentially fatal complication. PATIENT An elderly, non-diabetic patient with renal impairment presented with a possible duodenal perforation. After successful surgery, the patient developed recurrent hypoglycemic episodes in the post-operative period after use of levofloxacin. Delay in recognition of the cause of hypoglycemia led to irreversible brain damage and death. RESULTS The calculated Naranjo adverse drug reaction probability scale criteria suggest the possibility that these episodes were related to levofloxacin. The mechanism of hypoglycemia with levofloxacin relates to the potential inhibition of the K(ATP) channel on the pancreatic beta cell by the drug. CONCLUSION The case report highlights the need to be aware of this potentially fatal complication of a drug commonly used in surgical practice.
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Affiliation(s)
- Madhurita Singh
- Department of Anesthesia and Critical Care, Christian Medical College and Hospital, Ludhiana, Punjab, 632004, India
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Tayama Y, Miyake K, Nagafuji T, Gouhara T, Morita S, Arai S, Sato E, Kitaura T, Kihira K. [Influence of tacrolimus and ciprofloxacin on glucose metabolism]. YAKUGAKU ZASSHI 2007; 127:1883-9. [PMID: 17978565 DOI: 10.1248/yakushi.127.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Tacrolimus is an immunosuppressive drug that causes glucose intolerance. On the other hand, ciprofloxacin, which is widely used in the treatment of infectious diseases, is known to cause hypoglycemia as a side effect. We investigated the effects of tacrolimus and ciprofloxacin on serum glucose and insulin levels in rats, as well as on insulin secretion and the viability of HIT-T15 cells. The rats received intraperitoneal injections of tacrolimus and/or ciprofloxacin for 1 week, and their arterial blood was sampled after the administration of glucose. HIT-T15 cells were cultured in the presence of tacrolimus and/or ciprofloxacin, and the insulin level in the supernatant was measured. Ciprofloxacin did not show a significant effect on serum glucose and insulin levels after multiple administrations in the rats. In contrast, rats in the tacrolimus treatment group showed low serum insulin and high serum glucose levels. Moreover, the coadministration of ciprofloxacin and tacrolimus resulted in higher glucose levels compared with tacrolimus alone 0.5 h after glucose stimulation. In addition, we observed that the rats administered tacrolimus and/or ciprofloxacin had low body weight and food intake. Tacrolimus caused a dose-dependent decrease in the viability of the HIT-T15 cells. Furthermore, both drugs were highly toxic to HIT-T15 cells. In contrast, tacrolimus alone and coadministration of the drugs resulted in no significant difference in insulin secretion. These results suggest that the cytotoxic effects of ciprofloxacin and tacrolimus cause a decrease in insulin secretion, leading to glucose intolerance.
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Affiliation(s)
- Yoshitaka Tayama
- Faculty of Pharmaceutical Science, Hiroshima International University, Hirokoshingai, Kure City, Japan
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Ge TF, Law PYP, Wong HY, Ho YY. Gatifloxacin affects GLUT1 gene expression and disturbs glucose homeostasis in vitro. Eur J Pharmacol 2007; 573:70-4. [PMID: 17727838 DOI: 10.1016/j.ejphar.2007.07.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 07/21/2007] [Accepted: 07/23/2007] [Indexed: 11/25/2022]
Abstract
Gatifloxacin may induce life-threatening dysglycemia. The facilitated glucose transporter type 1 (GLUT1) protein is ubiquitously expressed in many tissues. Disturbed GLUT1 protein function weakens the systemic glycemic control and may cause dysglycemia. In this study we demonstrate that gatifloxacin modulates the transcription and reduces the expression and function of GLUT1 gene in HepG2 cells. When treated with gatifloxacin at concentrations of 3.4 mug/ml (8.4 muM) and 17 mug/ml (42 muM), GLUT1 promoter activity was stimulated by 2.8 and 3.8 folds, GLUT1 mRNA expression was decreased by 41% and 31%, and glucose uptake was decreased by 41% and 52%, respectively. Our findings imply that disturbed GLUT1 gene expression and protein function may underlie the dysglycemic effect of gatifloxacin.
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Affiliation(s)
- Tian-Fang Ge
- The Molecular Biotechnology Programme, The Chinese University of Hong Kong, Hong Kong SAR, China
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