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Ziamanesh F, Rashidian H, Mohseni S, Behzad G, Ebrahimpur M, Pejman Sani M, Payab M, Fooladgar M, Mohajeri-Tehrani MR, Larijani B. Hypoglycemia in non-diabetic in-patients at a teaching referral hospital in Iran. J Diabetes Metab Disord 2024; 23:759-763. [PMID: 38932802 PMCID: PMC11196425 DOI: 10.1007/s40200-023-01346-7] [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: 07/12/2023] [Accepted: 11/08/2023] [Indexed: 06/28/2024]
Abstract
Purpose This study aims to investigate comorbidities, clinical features, laboratory values, and diagnoses in non-diabetic patients experiencing hypoglycemic episodes. Methods A retrospective observational study was conducted at Shariati Hospital in Iran from 2016 to 2023. Seventy-four non-diabetic patients admitted with a diagnosis of hypoglycemia were included, while patients with diabetes were excluded. Demographic data, symptoms, and biochemical assessments were obtained from the hospital information system. Hypoglycemic episodes were identified based on low measured blood glucose, recorded medications for hypoglycemia treatment, or recorded codes indicating hypoglycemia. Hypoglycemia was defined as blood glucose below 70 mg/dL (3.9 mmol/L) along with two other criteria of the Whipple triad. Statistical analysis was performed using SPSS software (version 26). Results Among the enrolled patients, 63.5% were female, and 13.5% were elderly (≥ 65 years). The most common comorbidities observed were cardiovascular disease (20.3%), psychological disorders (20.3%), hypothyroidism (14.9%), and hypertension (8.1%). The prevalent symptoms included weakness, loss of consciousness, sweating, palpitations, dizziness, and tremors. Non-diabetic hypoglycemia was caused by factitious disorders, insulinoma, organ failure, and infection, respectively. Conclusion Due to the diverse range of clinical symptoms, hypoglycemia in non-diabetic patients may be diagnosed late, leading to misdiagnoses such as psychological disorders or seizures. It is crucial to consider the possibility of hypoglycemia in non-diabetic patients and determine its underlying cause. Given the poor prognosis associated with hypoglycemia, timely interventions are essential.
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Affiliation(s)
- Fateme Ziamanesh
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Rashidian
- British Columbia Institute of Technology Vancouver, Vancouver, BC Canada
| | - Shahrzad Mohseni
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazal Behzad
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbube Ebrahimpur
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Pejman Sani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Payab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Fooladgar
- Fellowship, Department of Nephrology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohajeri-Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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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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Chen C, Hennessy S, Brensinger CM, Dawwas GK, Acton EK, Bilker WB, Chung SP, Dublin S, Horn JR, Miano TA, Pham Nguyen TP, Soprano SE, Leonard CE. Skeletal muscle relaxant drug-drug-drug interactions and unintentional traumatic injury: Screening to detect three-way drug interaction signals. Br J Clin Pharmacol 2022; 88:4773-4783. [PMID: 35562168 PMCID: PMC9560998 DOI: 10.1111/bcp.15395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022] Open
Abstract
AIM The aim of this study was to identify skeletal muscle relaxant (SMR) drug-drug-drug interaction (3DI) signals associated with increased rates of unintentional traumatic injury. METHODS We conducted automated high-throughput pharmacoepidemiologic screening of 2000-2019 healthcare data for members of United States commercial and Medicare Advantage health plans. We performed a self-controlled case series study for each drug triad consisting of an SMR base-pair (i.e., concomitant use of an SMR with another medication), and a co-dispensed medication (i.e., candidate interacting precipitant) taken during ongoing use of the base-pair. We included patients aged ≥16 years with an injury occurring during base-pair-exposed observation time. We used conditional Poisson regression to calculate adjusted rate ratios (RRs) with 95% confidence intervals (CIs) for injury with each SMR base-pair + candidate interacting precipitant (i.e., triad) versus the SMR-containing base-pair alone. RESULTS Among 58 478 triads, 29 were significantly positively associated with injury; confounder-adjusted RRs ranged from 1.39 (95% CI = 1.01-1.91) for tizanidine + omeprazole with gabapentin to 2.23 (95% CI = 1.02-4.87) for tizanidine + diclofenac with alprazolam. Most identified 3DI signals are new and have not been formally investigated. CONCLUSION We identified 29 SMR 3DI signals associated with increased rates of injury. Future aetiologic studies should confirm or refute these SMR 3DI signals.
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Affiliation(s)
- Cheng Chen
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
- Leonard Davis Institute of Health Economics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | - Colleen M. Brensinger
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | - Ghadeer K. Dawwas
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
- Leonard Davis Institute of Health Economics, University of Pennsylvania (Philadelphia, PA, US)
| | - Emily K. Acton
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | - Warren B. Bilker
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | | | - Sascha Dublin
- Kaiser Permanente Washington Health Research Institute (Seattle, WA, US)
- Department of Epidemiology, School of Public Health, University of Washington (Seattle, WA, US)
| | - John R. Horn
- Department of Pharmacy, School of Pharmacy, University of Washington (Seattle, WA, US)
| | - Todd A. Miano
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | - Thanh Phuong Pham Nguyen
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, Department of Neurology, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Samantha E. Soprano
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
| | - Charles E. Leonard
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Philadelphia, PA, US)
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania (Philadelphia, PA, US)
- Leonard Davis Institute of Health Economics, University of Pennsylvania (Philadelphia, PA, US)
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Matoi A, Taguchi M, Nishi S. Fatal hypoglycemia with ciprofloxacin in a dialysis patient: A case report. Clin Case Rep 2021; 9:1902-1904. [PMID: 33936612 PMCID: PMC8077382 DOI: 10.1002/ccr3.3871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/07/2022] Open
Abstract
In patients with renal dysfunction, it is important to avoid prescribing fluoroquinolones including ciprofloxacin.
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Affiliation(s)
- Aisa Matoi
- Intensive Care UnitHyogo College of MedicineNishinomiyaJapan
| | - Mana Taguchi
- Intensive Care UnitHyogo College of MedicineNishinomiyaJapan
| | - Shinichi Nishi
- Intensive Care UnitHyogo College of MedicineNishinomiyaJapan
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5
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Eren M, Bostan F. Non- pancreatic neuroendocrine tumour presenting with hypoglycemia in an elderly patient. Afr Health Sci 2020; 20:1875-1879. [PMID: 34394252 PMCID: PMC8351849 DOI: 10.4314/ahs.v20i4.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hypoglycemia is a common, symptom seen in individuals. Hypoglycemia in the elderly is both under-recognized and misdiagnosed due to nonspesific hypoglycemic symptoms and accompanying comorbidities in this population. In diabetic individuals, hypoglycemia is most commonly caused by administering insulin or sulphonylureas and insulin secretagogues. Other drugs, such as antibiotics or beta-blockers, have been reported to reduce blood glucose to abnormally low levels. Hypoglycemia in non-diabetic patients is considered a rare event, and the possible reasons may be reactive hypoglycemia, insulin-secreting tumours and other malignancies, hypopituitarism, hypocortisolism, alcohol abuse, inappropriate insulin self-administration, malnutrition, renal failure and sepsis. Case An 86- year- old male was admitted to the emergency department with hypoglycemia diagnosed with non-pancreatic neuroendocrine tumour (NET) on lung secreting insulin. No surgical intervention or chemotherapy was planned due to patients age and comorbidities so best supportive care was planned. We used prednisone for symptomatic treatment of hypoglycemia and the patient has been followed up periodically. In this period he had no hypoglycemic attack. Conclusion For patients with hypoglycemia who are unable/decline to receive any further treatment, low dose glucocorticoid is a good choice to achieve normoglycemia. It seems to be more cost effective compared to other treatment options. Furthermore hospitalisation rates may decrease due to decreased hypogylcemic attacks.
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Affiliation(s)
- Merve Eren
- Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya
| | - Feyzi Bostan
- Department of Internal Medicine, University of Health Sciences Antalya Training and Research Hospital, Antalya
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Swart F, Bianchi G, Lenzi J, Iommi M, Maestri L, Raschi E, Zoli M, Ponti FD, Poluzzi E. Risk of hospitalization from drug-drug interactions in the Elderly: real-world evidence in a large administrative database. Aging (Albany NY) 2020; 12:19711-19739. [PMID: 33024058 PMCID: PMC7732312 DOI: 10.18632/aging.104018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/22/2020] [Indexed: 01/24/2023]
Abstract
The aim of this study was to assess the risk of hospitalization associated with the concomitant prescription of 10 highly prevalent drug-drug interactions (DDIs) among all individuals aged ≥65 residing in Bologna's area, Italy. We used incidence density sampling, and the effect of current (last month) and past (≥30 days before) exposure to DDI was investigated through conditional multivariable logistic regression analysis. Two DDIs were associated with increased hospitalization due to DDI related conditions: ACE-inhibitors/ diuretics plus glucocorticoids (current DDI: OR 2.36, 95% CI 1.94-2.87; past DDI: OR 1.36, 95% CI 1.12-1.65) and antidiabetic therapy plus current use of fluoroquinolones (OR 4.43, 95% CI 1.61-11.2). Non-Steroidal Anti-inflammatory Drugs (NSAIDs) increased the risk of re-bleeding in patients taking Selective Serotonin Reuptake Inhibitors (OR 5.56, 95% CI 1.24-24.9), while no significant effect was found in those without a history of bleeding episodes. Concomitant prescription of NSAIDs and ACE-inhibitors/diuretics in patients with a history of high-risk conditions was infrequent. Within the pattern of drug prescriptions in the older population of Bologna's area, we distinguished DDIs with actual clinical consequences from others that might be considered generally safe. Observed prescribing habits of clinicians reflect awareness of potential interactions in patients at risk.
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Affiliation(s)
- Floor Swart
- School of Medicine, Vrije University of Amsterdam, Amsterdam, The Netherlands
| | - Giampaolo Bianchi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Lorenzo Maestri
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Zoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
| | - Fabrizio De Ponti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
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Ciprofloxacin and risk of hypolycemia in non-diabetic patients. J Med Case Rep 2019; 13:142. [PMID: 31078137 PMCID: PMC6511658 DOI: 10.1186/s13256-019-2083-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 04/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Fluoroquinolones have been associated with hypoglycemia in patients taking diabetic medications, most commonly due to drug-drug interactions and other associated risk factors. Except for four published case reports, there are no studies that have found positive associations between ciprofloxacin and hypoglycemia. In all but one of the cases, ciprofloxacin was taken with other hypoglycemic drugs. Recently, the Eritrean National Pharmacovigilance Centre received a serious case of hypoglycemia with recurrent episodes in a young and healthy patient without diabetes following use of oral ciprofloxacin. The aim of the present study is therefore to assess the causal relationship between ciprofloxacin and hypoglycemia in patients without diabetes using the World Health Organization-Uppsala Monitoring Centre global adverse drug reaction database (VigiBase®). Methods A search was made on the World Health Organization global adverse drug reaction database (August 15, 2018) using “ciprofloxacin” as the drug substance and “hypoglycemia” as the reaction term. Cases that used hypoglycemic drugs (patients with diabetes) concurrently with ciprofloxacin and those with a completeness score below 50% were excluded to control for confounders and to improve the strength of the data. Hill criteria were used to assess causation. Results A total of 35 cases of hypoglycemia reported since 1989 from 17 countries in patients without diabetes associated with ciprofloxacin use with a median time to onset of 4 days were retrieved. The cases have a median age of 64 years (interquartile range, 50–85) with a similar male–to-female ratio. Ciprofloxacin was the only suspect and the sole drug administered in 48.5% of the cases. In ten cases, hypoglycemia abated following withdrawal of ciprofloxacin, and reaction recurred in one case on the subsequent rechallenge. Hypoglycemia was marked as “serious” in 20 cases, and the outcome was fatal in two cases. Conclusions This assessment found a suggestive causal link between use of ciprofloxacin and hypoglycemia in patients without diabetes.
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Successful Use of Octreotide Therapy for Refractory Levofloxacin-Induced Hypoglycemia: A Case Report and Literature Review. Case Rep Crit Care 2019; 2019:3560608. [PMID: 31210993 PMCID: PMC6532307 DOI: 10.1155/2019/3560608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 12/05/2022] Open
Abstract
Fluoroquinolones are commonly prescribed antimicrobials that have been implicated in alterations of glucose metabolism. We report a case of refractory fluoroquinolone-induced hypoglycemia in a patient with type-2 diabetes mellitus on glipizide that was successfully treated with octreotide. A patient was admitted with hypoglycemia after having been initiated on levofloxacin therapy. Despite treating the hypoglycemia supportively with multiple boluses of 25 g of dextrose, a continuous dextrose infusion, and glucagon, the patient experienced repeated episodes of rebound hypoglycemia. The persistent hypoglycemia was eventually reversed with the administration of subcutaneous octreotide. Clinicians should be cognizant of this adverse effect of fluoroquinolones, as well as predisposing risk factors, and consider octreotide as an adjunctive therapy for refractory hypoglycemia cases.
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Tomita T. [Research on Insufficient Information for Pharmaceutical Products]. YAKUGAKU ZASSHI 2017; 137:1497-1504. [PMID: 29199258 DOI: 10.1248/yakushi.17-00164] [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: 11/22/2022]
Abstract
Several issues concerning medicines remain unclear, including the availability of known, but not easily recognizable information. This review evaluates the mechanisms of side effects and the various risk indications included in package inserts. The results can be summarized as follows. 1) Short-term exposure to gatifloxacin significantly induced insulin secretion and increased the cytosolic Ca2+ concentration of islet cells by augmenting extracellular Ca2+ influx and its release from the endoplasmic reticulum. Alternatively, there was a decline in the cellular insulin level and reactivity to sulfonylurea after prolonged exposure. The insulin depletion was greater than that produced by other fluoroquinolones. 2) The elution of di(2-ethylhexyl)phthalate (DEHP) from the infusion set could be associated with the solubilizers in the injection medicines. The package inserts of several products containing polysorbate or ethanol had no warning about DEHP. Although there was a slight correlation between polysorbate content and descriptions on package inserts, the use of DEHP-containing devices was prohibited for some products, even with limited amounts of polysorbate. Therefore, the package insert statements should be reviewed to reflect appropriately the extent of DEHP elution. 3) Risk management plan consists of strategies to minimize the potential risks of medicines. One approach could be to introduce reminders on package inserts; however, of 268 potential risks associated with 81 products, 56 were not mentioned in package inserts. Because most postmarketing pharmacovigilance plans depend on spontaneous reporting by healthcare personnel, the descriptions on package inserts should be reexamined.
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Affiliation(s)
- Takashi Tomita
- Department of Pharmaceutical Services, Hiroshima University Hospital
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10
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Alencar LM, de Oliveira LH, Backes R, Rosa TM, de Oliveira PR, da Silva RAB, Trindade MAG. Liquid-liquid Extraction Coupled to Batch Injection Analysis for Electroanalysis of Levofloxacin at Low Concentration Level. ELECTROANAL 2017. [DOI: 10.1002/elan.201700364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Letícia Machado Alencar
- Faculdade de Ciências Exatas e Tecnologias; Universidade Federal da Grande Dourados; Rodovia Dourados-Itahum, km 12 Dourados-MS Brazil
| | - Luiz Henrique de Oliveira
- Faculdade de Ciências Exatas e Tecnologias; Universidade Federal da Grande Dourados; Rodovia Dourados-Itahum, km 12 Dourados-MS Brazil
| | - Rafael Backes
- Faculdade de Ciências Exatas e Tecnologias; Universidade Federal da Grande Dourados; Rodovia Dourados-Itahum, km 12 Dourados-MS Brazil
| | - Tamires Macedo Rosa
- Faculdade de Ciências Exatas e Tecnologias; Universidade Federal da Grande Dourados; Rodovia Dourados-Itahum, km 12 Dourados-MS Brazil
| | - Paulo Roberto de Oliveira
- Faculdade de Ciências Exatas e Tecnologias; Universidade Federal da Grande Dourados; Rodovia Dourados-Itahum, km 12 Dourados-MS Brazil
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Hyltén-Cavallius L, Iepsen EW, Wewer Albrechtsen NJ, Svendstrup M, Lubberding AF, Hartmann B, Jespersen T, Linneberg A, Christiansen M, Vestergaard H, Pedersen O, Holst JJ, Kanters JK, Hansen T, Torekov SS. Patients With Long-QT Syndrome Caused by Impaired hERG-Encoded K v11.1 Potassium Channel Have Exaggerated Endocrine Pancreatic and Incretin Function Associated With Reactive Hypoglycemia. Circulation 2017; 135:1705-1719. [PMID: 28235848 PMCID: PMC5412733 DOI: 10.1161/circulationaha.116.024279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/14/2017] [Indexed: 11/23/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Loss-of-function mutations in hERG (encoding the Kv11.1 voltage-gated potassium channel) cause long-QT syndrome type 2 (LQT2) because of prolonged cardiac repolarization. However, Kv11.1 is also present in pancreatic α and β cells and intestinal L and K cells, secreting glucagon, insulin, and the incretins glucagon-like peptide-1 (GLP-1) and GIP (glucose-dependent insulinotropic polypeptide), respectively. These hormones are crucial for glucose regulation, and long-QT syndrome may cause disturbed glucose regulation. We measured secretion of these hormones and cardiac repolarization in response to glucose ingestion in LQT2 patients with functional mutations in hERG and matched healthy participants, testing the hypothesis that LQT2 patients have increased incretin and β-cell function and decreased α-cell function, and thus lower glucose levels. Methods: Eleven patients with LQT2 and 22 sex-, age-, and body mass index–matched control participants underwent a 6-hour 75-g oral glucose tolerance test with ECG recording and blood sampling for measurements of glucose, insulin, C-peptide, glucagon, GLP-1, and GIP. Results: In comparison with matched control participants, LQT2 patients had 56% to 78% increased serum insulin, serum C-peptide, plasma GLP-1, and plasma GIP responses (P=0.03–0.001) and decreased plasma glucose levels after glucose ingestion (P=0.02) with more symptoms of hypoglycemia (P=0.04). Sixty-three percent of LQT2 patients developed hypoglycemic plasma glucose levels (<70 mg/dL) versus 36% control participants (P=0.16), and 18% patients developed serious hypoglycemia (<50 mg/dL) versus none of the controls. LQT2 patients had defective glucagon responses to low glucose, P=0.008. β-Cell function (Insulin Secretion Sensitivity Index-2) was 2-fold higher in LQT2 patients than in controls (4398 [95% confidence interval, 2259–8562] versus 2156 [1961–3201], P=0.03). Pharmacological Kv11.1 blockade (dofetilide) in rats had similar effect, and small interfering RNA inhibition of hERG in β and L cells increased insulin and GLP-1 secretion up to 50%. Glucose ingestion caused cardiac repolarization disturbances with increased QTc intervals in both patients and controls, but with a 122% greater increase in QTcF interval in LQT2 patients (P=0.004). Conclusions: Besides a prolonged cardiac repolarization phase, LQT2 patients display increased GLP-1, GIP, and insulin secretion and defective glucagon secretion, causing decreased plasma glucose and thus increased risk of hypoglycemia. Furthermore, glucose ingestion increased QT interval and aggravated the cardiac repolarization disturbances in LQT2 patients. Clinical Trial Registration: URL: http://clinicaltrials.gov. Unique identifier: NCT02775513.
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Affiliation(s)
- Louise Hyltén-Cavallius
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Eva W Iepsen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Nicolai J Wewer Albrechtsen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Mathilde Svendstrup
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Anniek F Lubberding
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Bolette Hartmann
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Thomas Jespersen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Allan Linneberg
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Michael Christiansen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Henrik Vestergaard
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Oluf Pedersen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Jens J Holst
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Jørgen K Kanters
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.)
| | - Torben Hansen
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.).
| | - Signe S Torekov
- From Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., A.F.L., B.H., T.J., M.C., J.J.H., J.K.K., S.S.T.); Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.H.-C., E.W.I., N.J.W.A., M.S., B.H., H.V., O.P., J.J.H., T.H., S.S.T.); Research Centre for Prevention and Health, the Capital Region of Denmark, Copenhagen (A.L.); Gentofte, Aalborg and Herlev University Hospitals, Denmark (J.K.K.); Faculty of Health Sciences, University of Southern Denmark, Odense (T.H.); Department of Clinical Experimental Research, Rigshospitalet, Denmark (A.L.); Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (A.L.); Danish Diabetes Academy, Odense, Denmark (E.W.I., M.S.); Department of Clinical Biochemistry, Statens Serum Institut, Copenhagen, Denmark (M.C.); and Steno Diabetes Center Copenhagen, Gentofte, Denmark (H.V.).
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Baskar AJA, Kulanthaisamy A, Singh DR, Kannappan V. Assessment of non-covalent interaction between insulin and some antibiotics in aqueous solution through ultrasonic studies and in silico docking analysis. J Mol Liq 2016. [DOI: 10.1016/j.molliq.2016.10.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zhanel GG, Fontaine S, Adam H, Schurek K, Mayer M, Noreddin AM, Gin AS, Rubinstein E, Hoban DJ. A Review of New Fluoroquinolones : Focus on their Use in Respiratory Tract Infections. ACTA ACUST UNITED AC 2016; 5:437-65. [PMID: 17154673 DOI: 10.2165/00151829-200605060-00009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The new respiratory fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, and on the horizon, garenoxacin) offer many improved qualities over older agents such as ciprofloxacin. These include retaining excellent activity against Gram-negative bacilli, with improved Gram-positive activity (including Streptococcus pneumoniae and Staphylococcus aureus). In addition, gatifloxacin, moxifloxacin and garenoxacin all demonstrate increased anaerobic activity (including activity against Bacteroides fragilis). The new fluoroquinolones possess greater bioavailability and longer serum half-lives compared with ciprofloxacin. The new fluoroquinolones allow for once-daily administration, which may improve patient adherence. The high bioavailability allows for rapid step down from intravenous administration to oral therapy, minimizing unnecessary hospitalization, which may decrease costs and improve quality of life of patients. Clinical trials involving the treatment of community-acquired respiratory infections (acute exacerbations of chronic bronchitis, acute sinusitis, and community-acquired pneumonia) demonstrate high bacterial eradication rates and clinical cure rates. In the treatment of community-acquired respiratory tract infections, the various new fluoroquinolones appear to be comparable to each other, but may be more effective than macrolide or cephalosporin-based regimens. However, additional data are required before it can be emphatically stated that the new fluoroquinolones as a class are responsible for better outcomes than comparators in community-acquired respiratory infections. Gemifloxacin (except for higher rates of hypersensitivity), levofloxacin, and moxifloxacin have relatively mild adverse effects that are more or less comparable to ciprofloxacin. In our opinion, gatifloxacin should not be used, due to glucose alterations which may be serious. Although all new fluoroquinolones react with metal ion-containing drugs (antacids), other drug interactions are relatively mild compared with ciprofloxacin. The new fluoroquinolones gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin have much to offer in terms of bacterial eradication, including activity against resistant respiratory pathogens such as penicillin-resistant, macrolide-resistant, and multidrug-resistant S. pneumoniae. However, ciprofloxacin-resistant organisms, including ciprofloxacin-resistant S. pneumoniae, are becoming more prevalent, thus prudent use must be exercised when prescribing these valuable agents.
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Affiliation(s)
- George G Zhanel
- Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, CanadaDepartment of Clinical Microbiology, Health Sciences Centre, Winnipeg, Manitoba, CanadaDepartment of Medicine, Health Sciences Centre, Winnipeg, Manitoba, Canada
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Risky Business. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Qiu HY, Yuan SS, Yang FY, Shi TT, Yang JK. HERG Protein Plays a Role in Moxifloxacin-Induced Hypoglycemia. J Diabetes Res 2016; 2016:6741745. [PMID: 26649323 PMCID: PMC4663361 DOI: 10.1155/2016/6741745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/06/2015] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to investigate the effect of moxifloxacin on HERG channel protein and glucose metabolism. HERG expression was investigated using immunohistochemistry. The whole-cell patch clamp method was used to examine the effect of moxifloxacin on HERG channel currents. A glucose tolerance test was used to analyze the effects of moxifloxacin on blood glucose and insulin concentrations in mice. Results show that HERG protein was expressed in human pancreatic β-cells. Moxifloxacin inhibited HERG time-dependent and tail currents in HEK293 cells in a concentration-dependent manner. The IC50 of moxifloxacin inhibition was 36.65 μmol/L. Moxifloxacin (200 mg/kg) reduced blood glucose levels and increased insulin secretion in wild-type mice at 60 min after the start of the glucose tolerance test. In contrast, moxifloxacin did not significantly alter blood glucose and insulin levels in HERG knockout mice. Serum glucose levels increased and insulin concentrations decreased in HERG knockout mice when compared to wild-type mice. The moxifloxacin-induced decrease in blood glucose and increase in insulin secretion occurred via the HERG protein; thus, HERG protein plays a role in insulin secretion.
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Affiliation(s)
- Hai-Yan Qiu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing 100730, China
| | - Sha-Sha Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing 100730, China
| | - Fang-Yuan Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing 100730, China
| | - Ting-Ting Shi
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing 100730, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing 100730, China
- *Jin-Kui Yang:
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Abstract
Tuberculosis (TB) remains a major public health problem, representing the second leading cause of death from infectious diseases globally, despite being nearly 100 % curable. Multidrug-resistant (MDR)-TB, a form of TB resistant to isoniazid and rifampicin (rifampin), two of the key first-line TB drugs, is becoming increasingly common. MDR-TB is treated with a combination of drugs that are less effective but more toxic than isoniazid and rifampicin. These drugs include fluoroquinolones, aminoglycosides, ethionamide, cycloserine, aminosalicyclic acid, linezolid and clofazimine among others. Minor adverse effects are quite common and they can be easily managed with symptomatic treatment. However, some adverse effects can be life-threatening, e.g. nephrotoxicity due to aminoglycosides, cardiotoxicity due to fluoroquinolones, gastrointestinal toxicity due to ethionamide or para-aminosalicylic acid, central nervous system toxicity due to cycloserine, etc. Baseline evaluation may help to identify patients who are at increased risk for adverse effects. Regular clinical and laboratory evaluation during treatment is very important to prevent adverse effects from becoming serious. Timely and intensive monitoring for, and management of adverse effects caused by, second-line drugs are essential components of drug-resistant TB control programmes; poor management of adverse effects increases the risk of non-adherence or irregular adherence to treatment, and may result in death or permanent morbidity. Treating physicians should have a thorough knowledge of the adverse effects associated with the use of second-line anti-TB drugs, and routinely monitor the occurrence of adverse drug reactions. In this review, we have compiled safety and tolerability information regarding second-line anti-TB drugs in both adults and children.
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Abstract
Patients with diabetes mellitus are often susceptible to hypoglycemic episodes while on therapy. Most of these are attributed to inappropriate dosing of hypoglycemic agents, dietary indiscretion, or acute illness. Medications being used concomitantly should be reviewed closely when the etiology of hypoglycemia is unclear. A fifty-six-year-old woman with a history of diabetes mellitus (on metformin monotherapy) was found unresponsive at home. Her fingerstick glucose was 15 mg/dL for which she received 50% dextrose intravenously. The patient never had any previous documented hypoglycemic episodes. She had recently been diagnosed with pneumonia and was prescribed oral levofloxacin therapy. The patient had taken 4 doses of levofloxacin before the onset of hypoglycemia. These episodes recurred over the next 2 days needing close intensive care unit monitoring, dextrose infusion, and glucagon administration. Basic blood/urine investigations, cortisol and thyroid profile were normal except for low blood glucose and renal insufficiency (serum creatinine 1.4 mg/dL and creatinine clearance 42 mL/min). HbA1c was 6.8% (4.4%-6.4%), insulin 51.3 μU/mL (2.6-24.9 μU/mL), IGF-1 301 ng/mL (27-223 ng/mL), and C peptide 9.3 ng/mL (0.8-3.5 ng/mL). These levels were elevated but were deemed nondiagnostic because of fluctuating glucose values after glucagon administration. A blood screen for sulfonylureas and metaglinides was negative. A seventy-two-hour fast was performed to rule out hyperinsulinemic hypoglycemic syndromes; however, blood glucose values remained consistently above 120 mg/dL during this period. Thus, after exclusion of other causes, we utilized the adverse drug reaction probability scale and concluded that hypoglycemia was probably related to recent use of levofloxacin.
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Wang Y, Law WK, Hu JS, Lin HQ, Ip TM, Wan DCC. Discovery of FDA-approved drugs as inhibitors of fatty acid binding protein 4 using molecular docking screening. J Chem Inf Model 2014; 54:3046-50. [PMID: 25360897 DOI: 10.1021/ci500503b] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
We first identified fluorescein, ketazolam, antrafenine, darifenacin, fosaprepitant, paliperidone, risperidone, pimozide, trovafloxacin, and levofloxacin as inhibitors of fatty acid binding protein 4 using molecular docking screening from FDA-approved drugs. Subsequently, the biochemical characterizations showed that levofloxacin directly inhibited FABP4 activity in both the in vitro ligand displacement assay and cell-based function assay. Furthermore, levofloxacin did not induce adipogenesis in adipocytes, which is the major adverse effect of FABP4 inhibitors.
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Affiliation(s)
- Yan Wang
- School of Biomedical Sciences, Faculty of Medicine, The Chinese University of Hong Kong , Shatin, Hong Kong SAR, China
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Chou HW, Wang JL, Chang CH, Lee JJ, Shau WY, Lai MS. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan. Clin Infect Dis 2013; 57:971-80. [PMID: 23948133 DOI: 10.1093/cid/cit439] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Observational studies and fatal case reports raise concern about the safety of severe dysglycemia associated with fluoroquinolone use. The objective of this study was to assess the risk of severe dysglycemia among diabetic patients who received different fluoroquinolones. METHODS In a population-based inception cohort study of diabetic patients covering the period from January 2006 to November 2007, outpatient new users of levofloxacin, ciprofloxacin, moxifloxacin, cephalosporins, and macrolides orally were identified. Study events were defined as emergency department visits or hospitalization for dysglycemia within 30 days following the initiation of antibiotic therapy. Results were analyzed with adjusted multinomial propensity score. RESULTS A total of 78 433 diabetic patients receiving the antibiotics of interest were included in the study. The absolute risk of hyperglycemia per 1000 persons was 6.9 for moxifloxacin and 1.6 for macrolides. In contrast, the risk of hypoglycemia was 10.0 for moxifloxacin and 3.7 for macrolides. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of levofloxacin, ciprofloxacin, and moxifloxacin compared with macrolides were 1.75 (1.12-2.73), 1.87 (1.20-2.93), and 2.48 (1.50-4.12), respectively, for hyperglycemia and 1.79 (1.33-2.42), 1.46 (1.07-2.00), and 2.13 (1.44-3.14), respectively, for hypoglycemia. Patients taking moxifloxacin faced a significantly higher risk of hypoglycemia than those receiving ciprofloxacin. A significant increase in the risk of hypoglycemia was also observed among patients receiving moxifloxacin concomitantly with insulin (AOR, 2.28; 95% CI, 1.22-4.24). CONCLUSIONS Diabetics using oral fluoroquinolones faced greater risk of severe dysglycemia. The risk of hypoglycemia varied according to the type of fluoroquinolone administered, and was most commonly associated with moxifloxacin.
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Affiliation(s)
- Hsu-Wen Chou
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
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Kapoor R, Blum D, Batra A, Varma N, Lakshmi K, Basak P, Jesmajian S. Life-Threatening Hypoglycemia With Moxifloxacin in a Dialysis Patient. J Clin Pharmacol 2013; 52:269-71. [DOI: 10.1177/0091270010391788] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pugi A, Longo L, Bartoloni A, Rossolini GM, Mugelli A, Vannacci A, Lapi F. Cardiovascular and metabolic safety profiles of the fluoroquinolones. Expert Opin Drug Saf 2011; 11:53-69. [PMID: 21958023 DOI: 10.1517/14740338.2011.624512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Certain fluoroquinolones share similar indications of use. A comparison among Cardiovascular and metabolic (i.e., dysglycemia) safety profiles of the fluoroquinolones might be particularly useful for the prescribers' decision-making process as well as to hypothesize future researcher purposes. AREAS COVERED A literature search was conducted using keywords apt to identify information on safety profile of the fluoroquinolones. Publications concerned with descriptive and etiological surveys were manually reviewed. EXPERT OPINION Cardiac alterations and blood glucose impairments might be associated with any fluoroquinolone. However, the benefit/risk profile of these agents could be stratified for the single compounds. Several predisposing factors, such as diabetes, heart illnesses and their related pharmacotherapies, might exacerbate the risk of potentially serious adverse events. In this context, the opportunity of the more appropriate choice among different fluoroquinolones could be applicable.
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Affiliation(s)
- Alessandra Pugi
- University of Florence, Department of Pharmacology, Viale Pieraccini 6, 50139, Florence, Italy.
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Israël M, Schwartz L. The metabolic advantage of tumor cells. Mol Cancer 2011; 10:70. [PMID: 21649891 PMCID: PMC3118193 DOI: 10.1186/1476-4598-10-70] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 06/07/2011] [Indexed: 12/21/2022] Open
Abstract
1- Oncogenes express proteins of "Tyrosine kinase receptor pathways", a receptor family including insulin or IGF-Growth Hormone receptors. Other oncogenes alter the PP2A phosphatase brake over these kinases. 2- Experiments on pancreatectomized animals; treated with pure insulin or total pancreatic extracts, showed that choline in the extract, preserved them from hepatomas. Since choline is a methyle donor, and since methylation regulates PP2A, the choline protection may result from PP2A methylation, which then attenuates kinases. 3- Moreover, kinases activated by the boosted signaling pathway inactivate pyruvate kinase and pyruvate dehydrogenase. In addition, demethylated PP2A would no longer dephosphorylate these enzymes. A "bottleneck" between glycolysis and the oxidative-citrate cycle interrupts the glycolytic pyruvate supply now provided via proteolysis and alanine transamination. This pyruvate forms lactate (Warburg effect) and NAD+ for glycolysis. Lipolysis and fatty acids provide acetyl CoA; the citrate condensation increases, unusual oxaloacetate sources are available. ATP citrate lyase follows, supporting aberrant transaminations with glutaminolysis and tumor lipogenesis. Truncated urea cycles, increased polyamine synthesis, consume the methyl donor SAM favoring carcinogenesis. 4- The decrease of butyrate, a histone deacetylase inhibitor, elicits epigenic changes (PETEN, P53, IGFBP decrease; hexokinase, fetal-genes-M2, increase). 5- IGFBP stops binding the IGF - IGFR complex, it is perhaps no longer inherited by a single mitotic daughter cell; leading to two daughter cells with a mitotic capability. 6- An excess of IGF induces a decrease of the major histocompatibility complex MHC1, Natural killer lymphocytes should eliminate such cells that start the tumor, unless the fever prostaglandin PGE2 or inflammation, inhibit them...
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Affiliation(s)
- Maurice Israël
- Ecole Polytechnique Palaiseau 91128 and Hôpital Raymond Poincaré, 104 Bd Raymond Poincaré Garches 92380m, France.
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Koeppe MO, Cristofoletti R, Fernandes EF, Storpirtis S, Junginger HE, Kopp S, Midha KK, Shah VP, Stavchansky S, Dressman JB, Barends DM. Biowaiver Monographs for Immediate Release Solid Oral Dosage Forms: Levofloxacin. J Pharm Sci 2011; 100:1628-36. [DOI: 10.1002/jps.22413] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 11/02/2010] [Accepted: 11/02/2010] [Indexed: 11/06/2022]
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Abstract
Drugs are the most frequent cause of hypoglycaemia in adults. Although hypoglycaemia is a well known adverse effect of antidiabetic agents, it may occasionally develop in the course of treatment with drugs used in everyday clinical practice, including NSAIDs, analgesics, antibacterials, antimalarials, antiarrhythmics, antidepressants and other miscellaneous agents. They induce hypoglycaemia by stimulating insulin release, reducing insulin clearance or interfering with glucose metabolism. Several drugs may also potentiate the hypoglycaemic effect of antidiabetic agents. Administration of these agents to individuals with diabetes mellitus is of most concern. Many of these drugs, and depending on clinical setting, may also induce hyperglycaemia. Drug-induced hepatotoxicity and nephrotoxicity may lead in certain circumstances to hypoglycaemia. Some drugs may also induce hypoglycaemia by causing pancreatitis. Drug-induced hypoglycaemia is usually mild but may be severe. Effective clinical management can be handled through awareness of this drug-induced adverse effect on blood glucose levels. Herein, we review pertinent clinical information on the incidence of drug-induced hypoglycaemia and discuss the underlying pathophysiological mechanisms, and prevention and management.
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Affiliation(s)
- Chaker Ben Salem
- Department of Clinical Pharmacology, Faculty of Medicine of Sousse, and Medical Intensive Care Unit, Sahloul University Hospital, Sousse, Tunisia.
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Abstract
The neuroendocrine response to critical illness is key to the maintenance of homeostasis. Many of the drugs administered routinely in the intensive care unit significantly impact the neuroendocrine system. These agents can disrupt the hypothalamic-pituitary-adrenal axis, cause thyroid abnormalities, and result in dysglycemia. Herein, we review major drug-induced endocrine disorders and highlight some of the controversies that remain in this area. We also discuss some of the more rare drug-induced syndromes that have been described in the intensive care unit. Drugs that may result in an intensive care unit admission secondary to an endocrine-related adverse event are also included. Unfortunately, very few studies have systematically addressed drug-induced endocrine disorders in the critically ill. Timely identification and appropriate management of drug-induced endocrine adverse events may potentially improve outcomes in the critically ill. However, more research is needed to fully understand the impact of medications on endocrine function in the intensive care unit.
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Garber SM, Pound MW, Miller SM. Hypoglycemia associated with the use of levofloxacin. Am J Health Syst Pharm 2009; 66:1014-9. [DOI: 10.2146/ajhp080105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Seth M. Garber
- Southwest Health Center, Unity Health, Inc., Washington, DC; at the time of writing he was Chief Resident, Family Medicine Residency, Duke/Southern Regional Area Health Education Center (AHEC), Fayetteville, NC
| | | | - Susan M. Miller
- School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, and Director of Pharmacotherapy Education, Duke/Southern Regional AHEC
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Abstract
Completing its initial phases of drug development in the mid 1990s as the one of the first fluoroquinolones that could be used with confidence to treat respiratory tract infections, levofloxacin went on to become one of the most widely prescribed antibiotics in the world. Available in both oral (po) and intravenous (IV) formulations and with characteristics of over 90% bioavailability, distribution into both extracellular and intracellular pulmonary compartments, highly predictable pharmacokinetics with over 90% of the drug being excreted unchanged in urine, and reliable activity against a broad spectrum of clinically important pathogens, levofloxacin has been used successfully to treat patients with a variety of serious infectious diseases as well as common infections most often treated outside of the hospital setting. Results of clinical trials involving patients with respiratory tract, urinary tract, and skin infections have consistently shown rates of clinical success and bacteriological eradication that were comparable to other widely used broad-spectrum agents. Regimens of levofloxacin, initially involving total daily doses of 250 mg to 500 mg, but more recently regimens involving 750 mg doses, have been shown to be safe and effective. Nearly a decade and a half of clinical experience has defined a safety and tolerability profile that permits data-driven assessment of the risks and benefits of using levofloxacin. As resistance to currently available fluoroquinolones has emerged, the clinical value of levofloxacin deserves continued evaluation. However, consistently high rates of susceptibility of clinically important bacteria, especially among those bacteria that commonly cause respiratory tract infections, such as Streptococcus pneumoniae and Haemophilus influenzae, suggest that this agent will continue to be a widely used well past the 20-year anniversary of its introduction into the antibacterial armamentarium.
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Affiliation(s)
- Gary J. Noel
- Johnson & Johnson Pharmaceutical Research and Development, LLC, Raritan, NJ, USA
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Kelesidis T, Canseco E. Levofloxacin-induced hypoglycemia: a rare but life-threatening side effect of a widely used antibiotic. Am J Med 2009; 122:e3-4. [PMID: 19272472 PMCID: PMC8086198 DOI: 10.1016/j.amjmed.2008.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 10/03/2008] [Accepted: 10/07/2008] [Indexed: 11/17/2022]
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Ghaly H, Kriete C, Sahin S, Pflöger A, Holzgrabe U, Zünkler BJ, Rustenbeck I. The insulinotropic effect of fluoroquinolones. Biochem Pharmacol 2008; 77:1040-52. [PMID: 19073153 DOI: 10.1016/j.bcp.2008.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 11/19/2008] [Accepted: 11/19/2008] [Indexed: 11/28/2022]
Abstract
Antimicrobial fluoroquinolones induce, with strongly varying frequency, life-threatening hypoglycemias, which is explained by their ability to block K(ATP) channels in pancreatic B-cells and thus to initiate insulin secretion. In apparent contradiction to this, we observed that none of the fluoroquinolones in this study (gatifloxacin, moxifloxacin, ciprofloxacin, and a number of fluorophenyl-substituted compounds) initiated insulin secretion of perifused mouse islets when the glucose concentration was basal (5mM). Only when the glucose concentration was stimulatory by itself (10mM), the fluoroquinolones enhanced secretion. The fluoroquinolones were ineffective on SUR1 Ko islets, which do not have functional K(ATP) channels. All of these fluoroquinolones depolarized the membrane potential of mouse B-cells (patch-clamping in the whole-cell mode). Using metabolically intact B-cells (perforated-patch mode) however, 100microM of gatifloxacin, ciprofloxacin or moxifloxacin were unable to depolarize when the glucose concentration was 5mM, whereas other K(ATP) channel blockers (tolbutamide and efaroxan) remained effective. Only at a very high concentration (500microM) gatifloxacin and moxifloxacin, but not ciprofloxacin induced repetitive depolarizations which could be antagonized by diazoxide. In the presence of 10mM glucose all fluoroquinolones which enhanced secretion markedly elevated cytosolic calcium concentration ([Ca(2+)](i)). In the presence of 5mM glucose gatifloxacin and moxifloxacin at 500microM but not at 100microM elevated [Ca(2+)](i). It is concluded that fluoroquinolones in the clinically relevant concentration range are not initiators, but rather enhancers of glucose-induced insulin secretion. The block of K(ATP) channels appears necessary but not sufficient to explain the hypoglycemic effect of fluoroquinolones.
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Affiliation(s)
- Hany Ghaly
- Institute of Pharmacology and Toxicology, University of Braunschweig, D-38106 Braunschweig, Germany
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Kodl CT, Seaquist ER. Practical strategies to normalize hyperglycemia without undue hypoglycemia in type 2 diabetes mellitus. Curr Diab Rep 2008; 8:375-82. [PMID: 18778586 DOI: 10.1007/s11892-008-0065-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Hypoglycemia is a common problem in pharmacologically treated patients with type 2 diabetes mellitus and can be a major barrier to achieving optimal glycemic control. For practitioners to minimize and treat hypoglycemia, it is important to understand the physiology, risk factors, and medications associated with hypoglycemia. Through education, lifestyle modifications, medication adjustments, and possibly re-examining glycemic goals, practitioners can reduce the incidence of hypoglycemia while still decreasing the risk of microvascular complications associated with hyperglycemia.
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Affiliation(s)
- Christopher T Kodl
- University of Minnesota, Division of Endocrinology, Diabetes, and Metabolism, Campus delivery code 1932, Suite 229, 717 Delaware Street SE, Minneapolis, MN 55414, USA
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LaPlante KL, Mersfelder TL, Ward KE, Quilliam BJ. Prevalence of and risk factors for dysglycemia in patients receiving gatifloxacin and levofloxacin in an outpatient setting. Pharmacotherapy 2008; 28:82-9. [PMID: 18154478 DOI: 10.1592/phco.28.1.82] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To assess the prevalence of dysglycemia (hypoglycemia or hyperglycemia) associated with oral levofloxacin and gatifloxacin therapy in an outpatient setting, and to determine the characteristics of patients who developed dysglycemia while receiving either fluoroquinolone. DESIGN Retrospective medical record review. SETTING Outpatient clinic of a Veterans Affairs teaching hospital. PATIENTS A total of 1573 patients who received oral levofloxacin (343 patients), gatifloxacin (589 patients), or azithromycin (as a control, 641 patients) between June 1, 2004, and May 31, 2006. MEASUREMENTS AND MAIN RESULTS Dysglycemia occurred in 33 patients: 13 (2.2%), 9 (2.6%), and 11 (1.7%), respectively, of those in the gatifloxacin, levofloxacin, and azithromycin groups. Of 13 patients who experienced a hyperglycemic event, 11 (84.6%) had diabetes mellitus. After adjustment for confounding factors, neither levofloxacin nor gatifloxacin were associated with increased odds of developing a dysglycemic event compared with azithromycin. Multivariate analysis demonstrated that lack of downward dosage adjustment based on creatinine clearance (odds ratio [OR] 10.3, 95% confidence interval [CI] 3.8-27.6), presence of diabetes (OR 17.1, 95% CI 3.1-94.9), or treatment with insulin (OR 5.3, 95% CI 1.8-15.7) or sulfonylureas (OR 3.6, 95% CI 1.3-10.4) independently increased dysglycemia risk. Obesity (body mass index > or = 30 kg/m(2)) was independently protective (OR 0.22, 95% CI 0.09-0.55) against dysglycemic events. CONCLUSION Levofloxacin and gatifloxacin were not significantly associated with increased dysglycemic events compared with azithromycin. Lack of downward fluoroquinolone dosage adjustment for renal function, presence of diabetes, and treatment with insulin or sulfonylureas each independently increased the risk of dysglycemia. Obesity was independently protective against dysglycemia. More data are needed on the contributing effects of diabetes, fluoroquinolone dosage, and concomitant drug therapy so that an appropriate risk-management strategy can be developed.
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Affiliation(s)
- Kerry L LaPlante
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Providence, Rhode Island, USA.
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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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Abstract
BACKGROUND Fluoroquinolones, including ciprofloxacin, levofloxacin, gemifloxacin, and moxifloxacin, represent a major advance in the development of antimicrobial agents. They offer significant activity against Gram-negative pathogens, while more advanced generation fluoroquinolones including levofloxacin, gemifloxacin, and moxifloxacin are significantly active against Gram-positive (e.g., Streptococcus pneumoniae for some members of the class), typical, atypical, and anaerobic pathogens. Fluoroquinolones have a pharmacokinetic/pharmacodynamic profile that exhibits concentration-dependent killing and good oral absorption, allowing for once-daily dosing. OBJECTIVE Review of data from fluoroquinolone studies, with an emphasis on the associated rare, but potentially clinically important, adverse events in specific patient populations. Review of clinical efficacy is included where relevant to the topic under discussion. METHODS A literature search was conducted using terms including fluoroquinolones, moxifloxacin, ciprofloxacin, levofloxacin, gatifloxacin, gemifloxacin, safety, adverse events, drug interactions, and pharmacokinetic parameters to identify literature providing information regarding the safety profile of specified fluoroquinolones in special patient populations (i.e., the elderly, patients with liver disease, kidney disease, glycemic disorder, those at risk for cardiovascular events). Although specific date criteria were not applied to the search, preference was given to more recent publications. Online databases searched include MEDLINE and EMBASE and relevant textbooks were utilized as well. FINDINGS Fluoroquinolones, when used either as monotherapy or as combination therapy depending on their individual indications, attain adequate concentrations for treating infections in different target sites, including epithelial lining fluid, alveolar macrophages, skin, and gastrointestinal tissues. Overall, fluoroquinolones have predictable and mild-to-moderate adverse-event profiles and are generally well tolerated. Findings of this review are limited by the availability of publications and case reports. CONCLUSIONS Fluoroquinolones, are associated with rare, but clinically important, adverse events in special patient populations (including the elderly; those with hepatic, renal, or glycemic disorders; and those at risk for cardiovascular events). Recognition of differences in the clinical efficacy and safety profiles of fluoroquinolones in special patient populations should lead to better antimicrobial agent selection.
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Affiliation(s)
- Paul B Iannini
- Department of Medicine, Danbury Hospital, Danbury, CT 06810, USA.
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Levofloxacino y fibrilación auricular. Semergen 2007. [DOI: 10.1016/s1138-3593(07)73907-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Iatrogenic hypoglycemia is the main factor limiting aggressive and optimal diabetes management. Rather than being an inevitable consequence of optimal glycemic control, however, hypoglycemia is avoidable and generally straightforward to manage when it occurs. Professional caregivers, patients, and their families are often fearful of hypoglycemia, even though most episodes are minor and easily self-treated. Understanding the factors contributing to hypoglycemia risk and how to minimize its occurrence is an essential part of diabetes care. Building on the physiologic fundamentals presented in the accompanying review, the incidence, mortality/morbidity, clinical symptoms, severity classification, and psychosocial impact of hypoglycemia are described here. Appropriate selection and titration of therapeutic agents, including insulin analogs with more predictable time-action profiles than human insulin formulations, can reduce hypoglycemia risk. Patient education about hypoglycemia prevention, including symptom recognition and necessity of rapid treatment, behavioral modification, and the importance of frequent blood glucose monitoring should accompany all therapeutic interventions.
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Affiliation(s)
- Patrick J Boyle
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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Abstract
PURPOSE The development of gatifloxacin-induced dysglycemia in 13 patients is described; the details of the 3 most severe cases are presented. SUMMARY Three elderly patients developed dysglycemia after initiation of gatifloxacin therapy. Both patients who developed hypoglycemia were receiving concomitant insulin or oral antidiabetic agents. Repeated doses of dextrose were required for management. The Naranjo et al. probability rating scale revealed that gatifloxacin was the probable cause in the majority of the 13 cases, primarily because of the temporal relationship with gatifloxacin and, in some instances, resolution of dysglycemia after drug discontinuation. Although the mechanism of gatifloxacin-induced hyperglycemia is not known, in vitro studies have found that certain quinolone antimicrobials can lower serum glucose levels by blocking adenosine 5'-triphosphate-dependent potassium channels in the pancreatic beta-cell, stimulating insulin release. It is difficult to unequivocally implicate gatifloxacin as the only cause of dysglycemia in the cases presented, as there are many explanations for poor glycemic control in hospitalized patients, such as stress, infection, decreased renal function, and concomitant drug therapies. However, the patients' medication regimens appeared to be stable before gatifloxacin administration. CONCLUSION Thirteen patients developed dysglycemia after receiving gatifloxacin. Gatifloxacin was found to be the probable cause in the majority of cases.
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Affiliation(s)
- Rosemary Zvonar
- Pharmacy Department, The Ottawa Hospital, Ottawa, Ontario K1Y 4E9, Canada.
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Tomita T, Onishi M, Sato E, Kimura Y, Kihira K. Gatifloxacin Induces Augmented Insulin Release and Intracellular Insulin Depletion of Pancreatic Islet Cells. Biol Pharm Bull 2007; 30:644-7. [PMID: 17409495 DOI: 10.1248/bpb.30.644] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many hypoglycemic and hyperglycemic episodes associated with clinical use of gatifloxacin (GFLX), a novel fluoroquinolone antimicrobial agent, have been reported in recent years. Some have reported hypoglycemia induced by fluoroquinolones, indicating that these agents may stimulate insulin secretion from pancreatic islet cells. In this study, we investigated the effect of GFLX on insulin homeostasis in islet cells using the insulin secreting cell line, HIT-T15. After 1 h incubation with over 100 microM of GFLX, insulin secretion from the cells was significantly augmented. However, the augmentation of insulin release induced by GFLX subsequently reached a plateau. Coincidentally, cellular insulin was decreased by 120 h incubation, and reactivity to re-stimulation by sulfonylurea was suppressed. The GFLX insulin depletion effect was stronger than the effects produced by such other fluoroquinolones as levofloxacin and ciprofloxacin. This study suggests that GFLX should induce insulin oversecretion from pancreatic islet cells in the short-term, and decrease insulin productivity or increase insulin disintegration in the long-term. These results are consistent with the clinical results of GFLX finding that hypoglycemic episodes were seen after a first single administration, and most hyperglycemic episodes were seen more than 2 d after the start of administration.
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Affiliation(s)
- Takashi Tomita
- Department of Pharmaceutical Services, Hiroshima University Hospital, Japan.
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Ishiwata Y, Itoga Y, Yasuhara M. Effect of levofloxacin on serum glucose concentration in rats. Eur J Pharmacol 2006; 551:168-74. [PMID: 17026994 DOI: 10.1016/j.ejphar.2006.08.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 08/30/2006] [Accepted: 08/31/2006] [Indexed: 11/26/2022]
Abstract
To clarify the mechanism of fluoroquinolone-induced abnormalities in blood glucose, the effect of levofloxacin on serum glucose concentration was investigated in rats. Rats received an intravenous injection of levofloxacin and their arterial blood was sampled periodically. The serum glucose concentration decreased after an injection of 100 mg/kg of levofloxacin, while it increased at levofloxacin 300 mg/kg. The serum immunoreactive insulin concentration increased as the dose of levofloxacin increased. The serum epinephrine concentration was rapidly elevated by levofloxacin at 300 mg/kg. The serum histamine concentration increased after injections of levofloxacin, 200 and 300 mg/kg. Diphenhydramine (1 mg/kg) antagonized the hyperglycemia induced by 300 mg/kg of levofloxacin. In an in vitro study, the release of epinephrine from the adrenal medulla in the presence of levofloxacin was determined. Levofloxacin (300 microg/ml) did not affect epinephrine release from the adrenal medulla. Levofloxacin can induce hypoglycemia and hyperglycemia in rats. Levofloxacin can promote histamine release, leading to an increased serum epinephrine concentration and hyperglycemia.
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Affiliation(s)
- Yasuyoshi Ishiwata
- Department of Hospital Pharmacy, School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo 113-8519, Japan
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Mannucci E, Monami M, Mannucci M, Chiasserini V, Nicoletti P, Gabbani L, Giglioli L, Masotti G, Marchionni N. Incidence and prognostic significance of hypoglycemia in hospitalized non-diabetic elderly patients. Aging Clin Exp Res 2006; 18:446-51. [PMID: 17167310 DOI: 10.1007/bf03324842] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS To assess the incidence and prognostic value of hypoglycemia in hospitalized non-diabetic elderly patients. METHODS An observational retrospective study, with a 3-year follow-up, was performed in a series of 678 patients aged over 65 years, admitted between January 1 2001 and December 31 2001 to the Units of Gerontology and Geriatrics of the Careggi University Hospital, Florence, Italy. Patients with diabetes mellitus were excluded. To determine the cumulative incidence of hypoglycemia, all measurements of venous or capillary blood glucose during hospital stay were taken into account. In-hospital mortality was determined from hospital discharge records. Information on all-cause, three-year mortality after hospital admission was obtained from the City of Florence Registry Office. RESULTS Hypoglycemia was observed in 8.6% of patients, and was asymptomatic in about 25% of cases. In-hospital mortality was significantly higher in patients with hypoglycemia (41.4% vs 14.3%; p<0.001), even after adjustment for potential confounders, including comorbidity, indices of malnutrition, and pharmacological treatment (adjusted OR 2.17[1.25;3.85]). 3-year mortality was significantly higher in patients with hypoglycemia during hospital stay, but the difference was not significant after adjustment for confounders. CONCLUSIONS Hypoglycemia is a prognostic marker of in-hospital mortality in non-diabetic hospitalized patients, even after adjustment for comorbidity and indices of malnutrition. Instead, it does not seem to have any relevant independent prognostic value in the longer term.
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Affiliation(s)
- Edoardo Mannucci
- Department of Critical Care and Surgery, Unit of Gerontology and Geriatrics, University of Florence, and Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141 Florence, Italy.
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Rouveix B. [Clinically significant toxicity and tolerance of the main antibiotics used in lower respiratory tract infections]. Med Mal Infect 2006; 36:697-705. [PMID: 16876974 DOI: 10.1016/j.medmal.2006.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 05/19/2006] [Indexed: 11/21/2022]
Abstract
The purpose of this article was not to review all reported adverse reactions of antibiotics used in the treatment of lower respiratory tract infections but rather to focus either on those which might have an impact on observance, efficacy, and resistance, or on rare but life-threatening adverse effects such as torsade de pointe. The latter are mostly predictable and prescribers should adhere to precautions and contraindications. For new antibiotics, the number of patients enrolled in phase I to III clinical trials is far to small to detect such rare adverse effects and large post registration tolerance surveys are mandatory. ss-lactams are well tolerated. The risk of anaphylactic reaction is magnified by patient reports and can be reduced by skin testing. Macrolides are well tolerated as well. The risk of cardiac toxicity should be reduced by assessing individual susceptibility and avoiding drug interactions. The tolerance to telithromycin, a new ketolide, is similar to that of macrolides. Serious toxic reactions such as convulsions, tendon rupture, torsade de pointe, and hypoglycemia are associated with the use of fluoroquinolones. Most of these adverse reactions can be often circumvented by avoiding exposure patients at risk. Quinupristin/dalfopristin can induce arthralgia and myalgia and the major adverse effects of linezolid are IMAO like reactions, reversible myelosuppression, and peripheral neuropathy. Most of the adverse antibiotic reactions are reported when precautions of use in susceptible patients are not taken into account. When they are, the safety/risk ratio is good.
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Affiliation(s)
- B Rouveix
- Service de pharmacologie clinique, CNRS UPRES A 8068, hôpital Cochin-Saint-Vincent-de-Paul, 27, rue du Faubourg-Saint-Jacques, 75679 Paris cedex 14, France.
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Kanbay M, Aydogan T, Bozalan R, Isik A, Uz B, Kaya A, Akcay A. A Rare but serious side effect of Levofloxacin: hypoglycemia in a geriatric patient. Diabetes Care 2006; 29:1716-7. [PMID: 16801617 DOI: 10.2337/dc06-0788] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
The fluoroquinolones can cause severe hypoglycemia in older individuals with diabetes who are taking oral hypoglycemic agents. We describe a patient without diabetes who had new-onset hypoglycemia when given oral levaquin for pneumonia that developed after cardiac bypass surgery. The condition manifested with profound neurologic disturbances and required intravenous dextrose and parenteral glucagon for treatment. No other cause could be identified, and the problem remitted a few days after administration of the antibiotic was stopped. Laboratory evaluation showed relatively inappropriate insulin elevation at the time of the hypoglycemic episodes, consistent with pancreatic beta-cell stimulation. The report highlights glucose-lowering as an adverse effect of the fluoroquinolone class of antibiotics in persons without diabetes or taking hypoglycemic medication. Although levaquin is useful as broad-spectrum therapy in a variety of situations, clinicians should be cognizant of the occurrence of potentially serious or even fatal hypoglycemia with its use.
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Affiliation(s)
- Susan Wang
- Department of Medicine, University of South Carolina School of Medicine, Columbia, South Carolina 29203, USA
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Lawrence KR, Adra M, Keir C. Hypoglycemia-induced anoxic brain injury possibly associated with levofloxacin. J Infect 2006; 52:e177-80. [PMID: 16269178 DOI: 10.1016/j.jinf.2005.08.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 08/22/2005] [Accepted: 08/24/2005] [Indexed: 01/22/2023]
Abstract
Reports linking alterations in blood glucose concentrations with fluoroquinolones, mostly gatifloxacin and ciprofloxacin, have been published. We describe an elderly, non-diabetic patient with steroid-induced hyperglycemia prescribed glyburide who later developed severe hypoglycemia resulting in anoxic brain injury soon after initiating therapy with levofloxacin.
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Affiliation(s)
- Kenneth R Lawrence
- Department of Pharmacy and Division of Infectious Disease and Geographic Medicine, Tufts-New England Medical Center, 750 Washington Street, P.O. Box 420, Boston, MA 02111, USA.
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Mohr JF, McKinnon PS, Peymann PJ, Kenton I, Septimus E, Okhuysen PC. A retrospective, comparative evaluation of dysglycemias in hospitalized patients receiving gatifloxacin, levofloxacin, ciprofloxacin, or ceftriaxone. Pharmacotherapy 2006; 25:1303-9. [PMID: 16185173 DOI: 10.1592/phco.2005.25.10.1303] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVES To compare rates of blood glucose abnormalities in hospitalized patients receiving fluoroquinolones or ceftriaxone, and to describe the characteristics of patients who develop blood glucose abnormalities while receiving these agents. DESIGN Retrospective chart review. SETTING Two community-based hospitals in the Houston, Texas, region. PATIENTS Seventeen thousand one hundred eight patients who received fluoroquinolones or ceftriaxone; of those, 101 received levofloxacin, gatifloxacin, or ceftriaxone and also had serum glucose concentrations above 200 or below 50 mg/dl within 72 hours of receiving the drug. MEASUREMENTS AND MAIN RESULTS Baseline demographics of patients with glucose abnormalities while receiving gatifloxacin, levofloxacin, or ceftriaxone were similar. Mean +/- SD patient age, weight, and estimated creatinine clearance were 67 +/- 17 years, 79 +/- 21 kg, and 52 +/- 32 ml/minute, respectively. Dysglycemia rates relative to treatment were as follows: gatifloxacin 76 (1.01%) of 7540 patients, levofloxacin 11 (0.93%) of 1179, ceftriaxone 14 (0.18%) of 7844, ciprofloxacin 0 (0%) of 545, and any fluoroquinolone 87 (0.94%) of 9264. Dysglycemia was more likely to occur in patients receiving any fluoroquinolone than in those receiving ceftriaxone (relative risk [RR] 3.32, 95% confidence interval (CI) 2.31-4.78, p < 0.05). The rate of dysglycemia did not differ with gatifloxacin and levofloxacin (RR 1.07, 95% CI 0.62-1.86, p = 0.8). Of the 101 patients with dysglycemias, hypoglycemia occurred in nine (9%) and hyperglycemia in 92 (91%). In a multivariate analysis of patients receiving fluoroquinolones, only concomitant sulfonylurea therapy was identified as an independent risk factor for development of hypoglycemia compared with patients who experienced hyperglycemia. CONCLUSION In the 17,108 patients receiving a fluoroquinolone or ceftriaxone, the rate of dysglycemia was greater in those receiving levofloxacin or gatifloxacin than in those receiving ceftriaxone. However, no difference was noted in the rate of glucose abnormalities with levofloxacin versus gatifloxacin. Clinicians should be aware of dysglycemic events that may occur in patients receiving fluoroquinolones, especially in those with diabetes mellitus or those receiving sulfonylureas.
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Affiliation(s)
- John F Mohr
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
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Frothingham R. Glucose Homeostasis Abnormalities Associated with Use of Gatifloxacin. Clin Infect Dis 2005; 41:1269-76. [PMID: 16206101 DOI: 10.1086/496929] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Accepted: 07/06/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND More than 20 published case reports have described an association between the use of gatifloxacin and hypoglycemia or hyperglycemia. We compare the rates of glucose homeostasis abnormality (GHA) adverse event reports (AERs) associated with the use of gatifloxacin and comparator quinolones. METHODS We obtained spontaneous AERs associated with the use of ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin from the US Food and Drug Administration that were reported between November 1997 and September 2003. We removed duplicate and foreign cases. We used specific coding terms to identify GHA AERs. We calculated GHA AER rates, using either the total number of AERs or estimated retail prescriptions as denominators. RESULTS The use of ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin was associated with 10,025 unique AERs in the United States, including 568 GHA AERs, 25 of which had fatality. Use of gatifloxacin was associated with 453 GHA AERs (80%) and 17 GHA AERs with fatality (68%). GHA AERs comprised 24% of all AERs associated with gatifloxacin, compared with ciprofloxacin (1.3%), levofloxacin (1.6%), and moxifloxacin (1.3%) (P<.0001 for each comparison). Use of gatifloxacin was associated with 477 GHA AERs per 10(7) retail prescriptions, compared with ciprofloxacin (4 GHA AERs), levofloxacin (11 GHA AERs), and moxifloxacin (39 GHA AERs) (P<.0001 for each comparison). Patients with GHA AERs were older and more likely to be receiving concomitant treatment for diabetes. Limitations of the study include the use of spontaneous adverse event reporting, which is incomplete and potentially biased. This analysis cannot be used alone to demonstrate causality. CONCLUSIONS Use of gatifloxacin is associated with a much higher rate of GHA AERs than are comparator quinolones. This analysis is consistent with the results of in vitro analyses, animal studies, human volunteer studies, case reports, and a large randomized trial. Alternatives to gatifloxacin should be used in patients with diabetes.
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Graumlich JF, Habis S, Avelino RR, Salverson SM, Gaddamanugu M, Jamma K, Aldag JC. Hypoglycemia in Inpatients After Gatifloxacin or Levofloxacin Therapy: Nested Case-Control Study. Pharmacotherapy 2005; 25:1296-302. [PMID: 16185172 DOI: 10.1592/phco.2005.25.10.1296] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES To compare the incidence of hypoglycemic events in patients exposed to gatifloxacin or levofloxacin, and to measure the odds of experiencing a hypoglycemic event after receiving gatifloxacin versus levofloxacin while adjusting for confounders. DESIGN Nested case-control study within a historical cohort. SETTING A tertiary care, 730-bed, teaching hospital in central Illinois. PATIENTS Seven thousand two hundred eighty-seven hospitalized patients who received gatifloxacin or levofloxacin therapy. MEASUREMENTS AND MAIN RESULTS A total of 113 patients (case patients) had blood glucose levels below 51 mg/dl; 113 control patients, matched for age and sex, had no hypoglycemia. Matched conditional logistic regression models adjusted the odds of having hypoglycemia for significant covariates. The 12-month incidence of hypoglycemia was 11/1000 patients after levofloxacin administration and 21/1000 patients after gatifloxacin (absolute risk increase 10/1000 patients, 95% confidence interval [CI] 4-16/1000). Renal failure, sepsis syndrome, and concomitant hypoglycemic drug therapy significantly predicted hypoglycemia. After adjustment for significant predictors, the odds of having hypoglycemia were 2.81 (95% CI 1.02-7.70) times higher after gatifloxacin than levofloxacin therapy. CONCLUSION Among inpatients, the incidence of hypoglycemic events is greater after treatment with gatifloxacin than levofloxacin. The odds of experiencing hypoglycemic events are greater with gatifloxacin even after adjusting for other hypoglycemia risk factors, such as concomitant hypoglycemic drugs, renal failure, and sepsis syndrome.
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Affiliation(s)
- James F Graumlich
- Department of Medicine, College of Medicine, University of Illinois, Peoria, IL 61637, USA
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Abstract
Several parenteral antimicrobials have been introduced into clinical practice over the course of the last decade. Some of these agents (e.g., linezolid, daptomycin, and tigecycline) are prototypes of new classes of compounds. In comparative clinical trials, these newer anti-infectives have been shown to be safe and to have low rates of discontinuation by patients. However, long-term use has revealed unique toxicities associated with the use of some of these drugs. The adverse events and potential drug interactions associated with the use of these antibiotics are variable and require familiarity with the safety profile of each drug. It is especially important that clinicians be able to recognize serious adverse events associated with the use of specific drugs, because most of the adverse events can be readily reversed by cessation of therapy.
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Affiliation(s)
- Gary E Stein
- Department of Medicine, Michigan State University, East Lansing, MI 48824, USA.
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