Can Maxitrol (dexamethasone and neomycin) increase blood sugar levels, specifically causing hyperglycemia?

Can Maxitrol Increase Blood Sugar Levels?

Yes, Maxitrol eye drops can increase blood sugar levels due to its dexamethasone component, which is a corticosteroid known to cause hyperglycemia through multiple mechanisms including impaired insulin secretion, increased insulin resistance, and enhanced hepatic gluconeogenesis. 1

Mechanism of Steroid-Induced Hyperglycemia

• Dexamethasone, a component of Maxitrol, leads to hyperglycemia through multiple pathways:

  • Impaired beta cell insulin secretion 1
  • Increased total body insulin resistance 1
  • Enhanced hepatic gluconeogenesis 1

• The hyperglycemic effect typically peaks 7-9 hours after dexamethasone administration 1

• The degree of hyperglycemia correlates directly with the steroid dose 1

Evidence for Topical Ophthalmic Steroids and Blood Glucose

• Intensive application of topical corticosteroid eye drops (dexamethasone disodium phosphate 0.1%) can cause statistically significant increases in blood glucose levels, particularly in patients with previously controlled diabetes mellitus 2

• In a study of diabetic patients receiving intensive topical dexamethasone eye drops (8 drops/day for 7 days), those with initially controlled diabetes (glucose <135 mg/dl) showed significant increases in blood glucose levels that returned to baseline after discontinuation 2

• Periocular dexamethasone injections in diabetic patients can cause marked hyperglycemic effects, with blood glucose levels increasing up to 100% (doubling) from baseline approximately 6 hours after administration 3

Risk Factors for Steroid-Induced Hyperglycemia

• Pre-existing diabetes significantly increases the risk of hyperglycemia with steroid use 2, 3

• Other risk factors associated with higher blood glucose elevations include:

  • Older age 3
  • Longer duration of diabetes 3
  • Presence of diabetic micro or macroangiopathy 3
  • Higher baseline HbA1c levels 3

• Even in non-diabetic patients, single-dose dexamethasone can cause transient hyperglycemia, with peak effects typically observed on the first day following administration 4

Monitoring Recommendations

• For patients on topical steroids like Maxitrol who have diabetes or are at risk:

  • Monitor blood glucose levels, particularly 6-9 hours after application when hyperglycemic effects peak 1, 3
  • Pay special attention to patients with previously controlled diabetes, as they may experience significant but reversible increases in blood glucose 2

• For patients with diabetes receiving Maxitrol:

  • Those with HbA1c >7.5% may require additional hypoglycemic treatment during therapy 3
  • Blood glucose typically returns to baseline levels after discontinuation of the steroid 2

Management Strategies

• For patients experiencing hyperglycemia while using Maxitrol:

  • Consider temporary adjustments to diabetes medications if hyperglycemia is significant 1
  • Educate patients about symptoms of hyperglycemia to monitor for 1
  • If severe or persistent hyperglycemia occurs, consult with the patient's primary care physician or endocrinologist 1

• For patients with diabetes who require Maxitrol therapy:

  • More vigilant blood glucose monitoring is recommended, especially during the first few days of treatment 2, 3
  • Be prepared to adjust diabetes medications temporarily if needed 1

Clinical Pearls and Pitfalls

• The hyperglycemic effect of topical steroids is often underestimated in clinical practice 5

• Different corticosteroids have varying hyperglycemic potentials, with dexamethasone (found in Maxitrol) showing greater hyperglycemic effects compared to prednisolone and hydrocortisone 6

• Blood glucose typically returns to baseline after discontinuation of the steroid, but monitoring during the transition period is important 2

• Even short-term use of topical steroids can affect glycemic control in susceptible individuals 2, 3