RT Book, Section
A1 Masharani, Umesh
A2 Papadakis, Maxine A.
A2 McPhee, Stephen J.
A2 Rabow, Michael W.
A2 McQuaid, Kenneth R.
SR Print(0)
ID 1184162677
T1 Medication- & Ethanol-Induced Hypoglycemia
T2 Current Medical Diagnosis & Treatment 2022
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264269389
LK accessmedicine.mhmedical.com/content.aspx?aid=1184162677
RD 2024/04/19
AB A  number  of  medications  apart  from  diabetic  medications  can  occasionally  cause  hypoglycemia.  Common  offenders  include  the  fluoroquinolones  such  as  gatifloxacin  and  levofloxacin,  pentamidine,  quinine,  ACE  inhibitors,  salicylates  and  beta-adrenergic  blocking  agents.  The  fluoroquinolones,  particularly  gatifloxacin,  have  been  associated  with  both  hypoglycemia  and  hyperglycemia.  It  is  thought  that  the  drug  acts  on  the  ATP  sensitive  potassium  channels  in  the  beta  cell.  Hypoglycemia  is  an  early  event,  and  hyperglycemia  occurs  several  days  into  therapy.  Intravenous  pentamidine  is  cytotoxic  to  beta  cells  and  causes  acute  hyperinsulinemia  and  hypoglycemia  followed  by  insulinopenia  and  hyperglycemia.  Fasting  patients  taking  noncardioselective  beta-blockers  can  have  an  exaggerated  hypoglycemic  response  to  starvation.  The  beta-blockade  inhibits  fatty  acids  and  gluconeogenesis  substrate  release  and  reduces  plasma  glucagon  response.  Therapy  with  ACE  inhibitors  increases  the  risk  of  hypoglycemia  in  patients  who  are  taking  insulin  or  sulfonylureas  presumably  because  these  drugs  increase  sensitivity  to  circulating  insulin  by  increasing  blood  flow  to  the  muscle.  Some  opioids  cause  hypoglycemia.  Tramadol  use  has  been  associated  with  increased  risk  of  hospitalization  for  hypoglycemia.  Methadone  overdose  has  also  been  reported  to  cause  hypoglycemia  and  a  rapid  dose  escalation  of  methadone  in  cancer  patients  can  lower  glucose  levels.