Hypoglycemia secondary to trimethoprim/sulfamethoxazole administration in a renal transplant patient
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J A Johnson1, J E Kappel, M N Sharif
1College of Pharmacy, University of Saskatchewan, Saskatoon, Canada.
Objective:
To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycemia in an immunosuppressed renal transplant patient.
Data Source:
English-language journal articles and reference texts identified via a MEDLINE search and a bibliographic review of pertinent data sources.
Data Synthesis:
Hypoglycemia resulting from the combination of sulfonylureas and sulfonamides is a recognized drug interaction. Hypoglycemia induced by sulfonamides alone may be encountered less frequently. Previously reported cases of TMP/SMX-induced hypoglycemia postulated that the sulfonamide mimics hypoglycemic sulfonylurea agents and stimulates pancreatic islet cells to secrete insulin. We report a case of hypoglycemia following the administration of high-dose TMP/SMX in a renal transplant patient. Elevated C-peptide concentrations following the hypoglycemic episode indicate that hypoglycemia resulted from increased endogenous insulin secretion.
Conclusions:
Hypoglycemia has been a rarely encountered result of TMP/SMX use. Patients receiving TMP/SMX, particularly those with impaired renal function and those receiving high doses, should be monitored closely for hypoglycemia.