Hypoglycemia



 Drugs - Pharmaceuticals 

Medical drugs and pharmaceuticals potentially causing hypoglycemia:

Hypoglycemia has been described in context with several pharmaceuticals of quite different origin. Often these were single and quite rare observations or reports without known mechanisms of action. They should, however, always be considered as one reason of causing hypoglycemia.
1.
A cause of hypoglycemia may be drug-induced toxic liver and kidney lesions. Hypoglycemia may become evident due to prescription of drugs despite preexisting liver or kidney failure. Quite often this is the case during simple pain relieving therapy with salicylates or antibiotic therapy with sulfonamides containing sulfamethoxazol.
2.
The stimulatory action of several drugs (including salicylates and antiarrhythmics) is still unknown, although stimulatory actions on insulin secretion have been observed.
3.
Never should the hypoglycemia provoking action of alcohol be underestimated. In patients under influence of alcohol presenting with unclear impaired consciousness a determination of the blood glucose is always mandatory !
4.
Therapy with acetyl salicylic acid in the range of grams may clinically be relevant due to its widespread use, predominantly when overdosed in children.
5.
We do not comment here upon the use of blood glucose lowering drugs designed for the treatment of diabetes (including insulin) - the oral antidiabetic agents, predominantly the sulfonylureas, if taken by non-diabetic patients.

 

© Starke/Saddig 2001 www.insulinoma.net
Drug class
Drug name (Generic)
Remarks
ANALGETICS
Salicylic acid derivatives
Acetylsalicylic acid (Aspirin®)
 stimulation of insulin secretion, renal insufficiency;
in children; inhibition of cerebral glucose metabolism
Pyrazolone-Derivatives
Phenazone, Propyphenazone
p-Aminophenol-Derivatives
Phenacetine, Paracetamol (Acetaminophen)
 acute liver necrosis; renal failure
Diclofenac, Indomethacine
ANTIARRHYTHMICS
Disopyramide, Chinidine, Flecainide, Propafenone
 stimulation of insulin secretion
ANTIMALARIAL DRUGS
Chinin - Derivatives
Chinin, Chloroquine, Mefloquine
insulin stimulation, inhibition of gluconeogenesis
ANTIBIOTICS
Sulfonamides
Trimethoprime + Sulfamethoxazol
 renal insufficiency
 
Tetracyclines
-
?
 
Pentamidine
Pneumocystis carinii - infection
ANTIMETABOLITES
Folic acid analogues
Methotrexate
 ? transport mechanisms ? independent of liver function
       
Betablocker
unselective ß-blockers
Propanolol
? : gluconeogenesis; glucose uptake in muscle
Psychopharm. drugs
Butyrophenones
Haloperidol
?
   
Fluoxetine, Clomipramine
stimulation of insulin secretion
MAO-Inhibitors
?
Tryptophane metabolism ?
Antithyroid drugs
Methimazole
Thiamazole
 Insulin-Auto-Immune-Syndrome ( = IAIS)
other drugs
ACE - Inhibitors
Enalapril, ... et al.
 possible increase of insulin sensitivity
Antiarrhythmic
Procainamide
 Lupus erythematosus & IAIS
Antihypertensive
Dihydralazine
 Lupus erythematosus & IAIS
Antihistaminics
?
?
Toxic Substances
Alcohol
Colchicin
Chloroform
Phosphorus
 Inhibition of gluconeogenesis
  Liver necrosis
Insectizides
Parathion
Liver necrosis
Toxins
Amanita phalloides
Liver necrosis

Source:
Starke A, Saddig C. Hypoglykämien im Erwachsenenalter. In: Diabetes mellitus. Urban & Fischer, München Jena, 2. Aufl. 2000, S. 775-782
Service FJ. Hypoglycemic disorders. New Engl J Med 332, 1995, 1144-1152
Virally ML, Guillausseau PJ. Hypoglycemia in adults. Diabetes & Metabolism 25, 1999, 477-490


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