Methadone
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Hypoglycaemia: case report A 54-year-old man developed hypoglycaemia during treatment with methadone. The man presented with multiple episodes of dizziness and weakness, along with increased sweating, palpitations and sometimes with syncope and confusion. He reported feeling better after having candy. Hence, during the last episode, he checked his blood sugar using a fingerstick and his glucose level was 42. He did not report urinary or bowel incontinence during the episodes. He had been admitted 2 months before presentation for gastroenteritis and respiratory infection; at the time, he had developed two hypoglycaemic episodes related to poor oral intake. He also had diabetes mellitus for 8 years but had not been receiving any hypoglycemic medication. He also reported a history of chronic back pain on treatment with methadone 65 mg/day (50mg in morning and 15mg at bedtime) [route not stated]. He reported being on the same dose for the last 7 months. He also had a medical history significant for end stage renal disease, congestive heart failure and peripheral artery disease. His blood glucose level at presentation was normal, however creatinine was elevated. He was admitted for further examinations. At that time, he experienced two episodes of spontaneous hypoglycaemia in the morning. His blood sugar levels was low, as were his serum insulin levels. His Cpeptide levels were mildly elevated. His imaging studies from the past year showed atrophic pancreas. Possible insulinoma was ruled out and his elevated C-peptide was attributed to the renal failure. A cosyntropin stimulation test ruled out adrenal insufficiency. Hence, a diagnosis of methadone-induced hypoglycaemia was suspected. A change from methadone to buprenorphine was planned, however, he refused the switch owing to his achieved stability on methadone. The man’s total methadone dose remained unchanged. However, instead of the initial 50mg in morning & 15mg at bedtime, his dose was modified to 30mg in morning and 35mg at bedtime. Following dose modification, he reported lesser hypoglycemic episodes. His condition improved within 3 days and he was discharged. At an outpatient follow-up visit, he did not report further hypoglycaemic episodes. Otalora Y, et al. Methadone induced hypoglycemia, improved on dose adjustment. Journal of Clinical and Translational Endocrinology: Case Reports 18: Dec 2020. Available 803515749 from: URL: http://doi.org/10.1016/j.jecr.2020.100071
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Reactions 21 Nov 2020 No. 1831
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