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Hypoglycaemia in an elderly patient: case report A 79-year old man developed hypoglycaemia during treatment with glimepiride, ciprofloxacin and metronidazole; a possible drug interaction between glimepiride and metronidazole was proposed. The man, who had stage IV chronic kidney disease and had been receiving daily oral glimepiride 1mg for type 2 diabetes mellitus for an unspecified length of time [duration of therapy not stated], started receiving ciprofloxacin and metronidazole for diverticulitis [routes and dosages not stated]. He progressively became lethargic and, 2 days after starting ciprofloxacin and metronidazole, he was brought into the emergency room in an unresponsive state. On admission, he had a glucose level of 28 mg/dL and was hypotensive and had abnormal renal function. The man’s blood glucose levels were monitored, and he was given IV glucose with short-term improvement, but his hypoglycaemia persisted. Twelve hours after admission, his hypotension worsened and he was transferred to the ICU. His antihypertensives were suspended, and he was given glucose and bicarbonate. Diverticulitis therapy was changed to IV metronidazole 500mg every 8 hours and piperacillin/tazobactam. Eighteen hours after admission, his hypoglycaemia continued despite repeated glucagon and glucose administration, and octreotide was initiated. His glucose level increased to 278 mg/dL. Glimepiride was switched to insulin glargine and was continued until his discharge. Author comment: The event "was rated a ’probable’ adverse reaction by the Naranjo algorithm. A number of factors contributed to the development of this complication, including fluoroquinolone-induced dysglycemia, acute-onchronic renal insufficiency and a possible drug interaction. . . [A]ssessment of the drug interaction using the Drug Interaction Probability Scale (DIPS) identified the interaction as possible." Covvey J, et al. Glimepiride-induced hypoglycemia with ciprofloxacin, metronidazole, and acute kidney injury. Hospital Pharmacy 45: 934-938, No. 12, Dec 2010. Available from: URL: http://dx.doi.org/10.1310/hpj4512-934 803048543 USA

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Reactions 29 Jan 2011 No. 1336