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Ciprofloxacin and risk of hypolycemia in non-diabetic patients
Abiel Berhe1,2, Mulugeta Russom3, Fithawit Bahran4
1Department of Diagnostic Imaging, Orotta National Referral Hospital, Asmara, Eritrea. abielberhe7@gmail.com.
Background:
Fluoroquinolones have been associated with hypoglycemia in patients taking diabetic medications, most commonly due to drug-drug interactions and other associated risk factors. Except for four published case reports, there are no studies that have found positive associations between ciprofloxacin and hypoglycemia. In all but one of the cases, ciprofloxacin was taken with other hypoglycemic drugs. Recently, the Eritrean National Pharmacovigilance Centre received a serious case of hypoglycemia with recurrent episodes in a young and healthy patient without diabetes following use of oral ciprofloxacin. The aim of the present study is therefore to assess the causal relationship between ciprofloxacin and hypoglycemia in patients without diabetes using the World Health Organization-Uppsala Monitoring Centre global adverse drug reaction database (VigiBase®).
Methods:
A search was made on the World Health Organization global adverse drug reaction database (August 15, 2018) using "ciprofloxacin" as the drug substance and "hypoglycemia" as the reaction term. Cases that used hypoglycemic drugs (patients with diabetes) concurrently with ciprofloxacin and those with a completeness score below 50% were excluded to control for confounders and to improve the strength of the data. Hill criteria were used to assess causation.
Results:
A total of 35 cases of hypoglycemia reported since 1989 from 17 countries in patients without diabetes associated with ciprofloxacin use with a median time to onset of 4 days were retrieved. The cases have a median age of 64 years (interquartile range, 50-85) with a similar male-to-female ratio. Ciprofloxacin was the only suspect and the sole drug administered in 48.5% of the cases. In ten cases, hypoglycemia abated following withdrawal of ciprofloxacin, and reaction recurred in one case on the subsequent rechallenge. Hypoglycemia was marked as "serious" in 20 cases, and the outcome was fatal in two cases.
Conclusions:
This assessment found a suggestive causal link between use of ciprofloxacin and hypoglycemia in patients without diabetes.
Insights
Ciprofloxacin may cause hypoglycemia in patients without diabetes. This study found a suggestive causal link, with serious and fatal outcomes reported in a review of global adverse drug reaction data.
Area of Science:
- Pharmacovigilance
- Clinical Pharmacology
- Drug Safety
Background:
- Fluoroquinolones, including ciprofloxacin, are linked to hypoglycemia, often due to drug interactions.
- Limited studies exist on ciprofloxacin and hypoglycemia, particularly in non-diabetic individuals.
- A recent case highlighted hypoglycemia in a young, healthy patient on oral ciprofloxacin.
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