From the Guidelines
Medications that can cause hypoglycemia include insulin, sulfonylureas, meglitinides, and certain non-diabetes medications such as quinine, pentamidine, and salicylates. The most recent and highest quality study, 1, highlights the importance of considering medication interactions that may precipitate hypoglycemia, particularly with sulfonylureas and commonly used antimicrobials. Some key points to consider include:
- Insulin is the most common cause of hypoglycemia
- Sulfonylureas, such as glipizide, glyburide, and glimepiride, can cause hypoglycemia, especially when combined with certain antimicrobials
- Meglitinides, like repaglinide and nateglinide, can also cause hypoglycemia
- Non-diabetes medications, such as quinine, pentamidine, and salicylates, can cause hypoglycemia, especially in high doses
- Beta-blockers may mask the symptoms of hypoglycemia while also potentially causing it
- ACE inhibitors can increase insulin sensitivity and lead to low blood sugar in diabetic patients
- Alcohol consumption significantly increases hypoglycemia risk, especially when combined with diabetes medications It is essential for patients taking these medications to be aware of hypoglycemia symptoms, such as shakiness, sweating, confusion, and rapid heartbeat, and to carry fast-acting carbohydrates like glucose tablets. Additionally, those on insulin or sulfonylureas should monitor their blood glucose regularly, especially when starting new medications or changing dosages, as recommended by 1 and 1. Overall, the mechanism behind medication-induced hypoglycemia typically involves either increased insulin secretion, enhanced insulin sensitivity, or interference with glucose production in the liver.
From the FDA Drug Label
DRUG INTERACTIONS • Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), and sulfonamide antibiotics (7). The medications that can cause hypoglycemia are:
- Antidiabetic agents
- ACE inhibitors
- Angiotensin II receptor blocking agents
- Disopyramide
- Fibrates
- Fluoxetine
- Monoamine oxidase inhibitors
- Pentoxifylline
- Pramlintide
- Salicylates
- Somatostatin analog (e.g., octreotide)
- Sulfonamide antibiotics 2
From the Research
Medications that Cause Hypoglycemia
Medications that can cause hypoglycemia include:
- Antidiabetic agents, such as sulfonylureas and insulin 3, 4, 5
- Non-steroidal anti-inflammatory drugs (NSAIDs) 3
- Analgesics 3
- Antibacterials 3
- Antimalarials 3
- Antiarrhythmics 3
- Antidepressants 3
- Beta-blockers, such as propranolol 4, 6
- Salicylates 4
- Quinine 4
- Pentamidine 4
- Ritodrine 4
- Disopyramide 4
- Angiotensin-converting enzyme (ACE) inhibitors 6
Mechanisms of Hypoglycemia
These medications can cause hypoglycemia by:
- Stimulating insulin release 3
- Reducing insulin clearance 3
- Interfering with glucose metabolism 3
- Potentiating the hypoglycemic effect of antidiabetic agents 3
- Causing pancreatitis 3
- Inducing hepatotoxicity or nephrotoxicity, which can lead to hypoglycemia 3
Clinical Considerations
It is essential to be aware of the potential for drug-induced hypoglycemia, especially in individuals with diabetes mellitus 3, 4, 5. Clinical factors that increase the risk of hypoglycemia include restricted food intake, age, hepatic disease, and renal disease 4. Effective management of drug-induced hypoglycemia requires prompt recognition and treatment, including administration of glucose and other medications as needed 4.