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Propoxyphene-induced hypoglycemia in renal failure
Pankaj Shah1, Jarek Aniszweski, F John Service
1Division of Endocrinology, Diabetes, Metabolism, & Nutrition, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
Summary
Propoxyphene can cause symptomatic hypoglycemia, particularly in patients with renal failure. Discontinuation of propoxyphene resolved recurrent hypoglycemia in a case study, highlighting the importance of medication history.
Area of Science:
- Clinical Pharmacology
- Nephrology
- Endocrinology
Background:
- Hypoglycemia is a critical concern, especially in patients with end-stage renal disease (ESRD).
- Accurate medication history is crucial for diagnosing drug-induced adverse events.
Observation:
- A 54-year-old male with chronic renal failure experienced recurrent symptomatic hypoglycemia (plasma glucose 40 mg/dL).
- Hypoglycemia persisted during propoxyphene treatment despite a 72-hour fast, with elevated insulin, C-peptide, and proinsulin levels.
- Drug screen excluded sulfonylureas, and calcium stimulation tests were negative.
Findings:
- Discontinuation of propoxyphene therapy led to the resolution of hypoglycemia.
- The patient remained hypoglycemia-free for at least two years after propoxyphene withdrawal.
- Propoxyphene was identified as the likely cause of recurrent hypoglycemia in this ESRD patient.
Implications:
- This case underscores the necessity of a comprehensive medication review in patients with renal failure presenting with hypoglycemic episodes.
- The mechanism of propoxyphene-induced hypoglycemia may involve non-opioid receptor interactions.
- Clinicians should consider propoxyphene as a potential cause of unexplained hypoglycemia in susceptible populations.
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