Possible gatifloxacin-induced hypoglycemia

To report a case of hypoglycemia in a patient receiving gatifloxacin for presumed exacerbation of chronic obstructive pulmonary disease (COPD).

A 73-year-old white man with an extensive past medical history significant for type 2 diabetes mellitus and COPD was prescribed gatifloxacin 400 mg/d for a COPD exacerbation. After 2 days of therapy, the patient presented to the emergency department (ED) reporting worsening symptoms; he had a blood glucose concentration of 22 mg/dL. Because he had not eaten well for several days, the patient discontinued his oral antidiabetic medications prior to presenting to the ED, but continued to take gatifloxacin. The patient had never before experienced a symptomatic hypoglycemic episode during the years of taking his antidiabetic medications. In the ED, he received 1 last dose of gatifloxacin and was treated aggressively with intravenous dextrose. By the end of his hospitalization, antidiabetic medication was restarted to control hyperglycemia.

Although gatifloxacin has been shown to alter glucose homeostasis, the mechanism of action has not been elucidated. Other recognized risk factors that contribute to the development of hypoglycemia are discussed. Our patient experienced hypoglycemia after receiving gatifloxacin and recovered 24 hours after discontinuation. The Naranjo probability scale suggests a possible drug-related event.

The temporal relationship of gatifloxacin administration and the hypoglycemic episode suggests that gatifloxacin likely precipitated the event. Clinicians should be aware of this adverse effect in patients taking gatifloxacin presenting with hypoglycemia.