Severe hypoglycemia associated with ievofloxacin in Type 2 diabetic patients receiving polytherapy: two case reports

摘要

Objective: Although hypoglycemia is known to be associated with Ievofloxacin, patients are continually being hospitalized because of this adverse event. Here we have reported two further cases of severe hypoglycemia and discussed the possibility that the hypoglycemia is the result of interactions between Ievofloxacin and certain drags, in order to alert physicians to be aware that geriatric patients, particularly those with Type 2 diabetes and in polytherapy, are at risk of showing this adverse reaction. Cases summary: A 91-year-old woman with Type 2 diabetes on metformin and glibenclamide, also under treatment with oral antihyperten-sive drugs, platelet antiaggregant, low-molecular-weight heparin and buprenorphine, was prescribed Ievofloxacin for a bacterial infection. Liver function and renal function parameters were within normal limits. After repeated administration of Ievofloxacin, her serum glycemic levels had decreased to 47 mg/dl and the patient was in a coma. After stopping levofloxacin her glycemia level returned to the normal value. A 61 year-old male, affected by tonsillar squamous cell carcinoma, with Type 2 diabetes on metformin and glibenclamide, under treatment with low-molecular-weight heparin for deep venous thrombosis, hydromorphone and undergoing nutritional support, was treated with Ievofloxacin for a bacterial infection. After 72 h the patient was unresponsive and his blood glucose levels were 38 mg/dl. After discontinuation of Ievofloxacin administration the patient was treated with glucose infusion and his glycemic values gradually returned to the normal range. Discussion: The causality relationship between the Ievofloxacin and the hypoglycemia was established using Nara-njo's ADR probability scale. These case reports confirm the literature data that serious hypoglycemia may develop due to the use of Ievofloxacin and appears to occur most frequently in elderly patients with Type 2 diabetes who are receiving oral hypoglycemic agents. We described the possible pharmaco-kinetic and pharmacodinamic mechanisms of the interaction between Ievofloxacin and the other drags. Conclusions: We hypothesized that the concomitant use of several drags and particularly Ievofloxacin in association with oral antidiabetic drugs, opioid analgesics and low-molecular-weight heparin could concur to cause this side effect. The safety and toler-ability of this anti-infective agent should be revised urgently.