Issue 131 Item 6 Are Quinolones Safe for Patients with Diabetes?

Recent reports have shown that Tequin (gatifloxacin) can cause SEVERE hypoglycemia when taken with oral diabetes meds…glyburide…glipizide…Prandin (repaglinide)…etc. There are also a some cases of hypoglycemia in patients taking other quinolones as Cipro (ciprofloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin) and others. While the quinolones are frequently used to treat infections in diabetes patients, they typically do not interact with oral hypoglycemic agents. There are, however, rare case reports of ciprofloxacin (Cipro), and most recently gatifloxacin (Tequin), inducing severe hypoglycemia in patients taking various diabetes medications. Although the mechanism of this interaction is unclear, these reports indicate that close monitoring of serum glucose levels is essential when using quinolones to treat diabetes patients.

Researchers suspect that quinolones stimulate pancreatic beta-cells to release more insulin…and lower glucose levels. Lower glucose levels usually occur after the first few quinolone doses.
But most diabetes patients getting a quinolone do not develop symptomatic hypoglycemia. You should tell your diabetes patients to monitor their blood glucose extra close after starting a quinolone.

Patients not exhibiting signs of hypoglycemia at the start of quinolone therapy, will not likely experience this phenomena for the rest of the treatment period. However, due to the persistent nature of the interactions observed with certain quinolones, exercise caution when giving these antibiotics to diabetes patients. Counsel patients to carry food or glucose tablets in case of hypoglycemia. Closely monitor patients for changes in serum glucose levels. Discontinue the quinolone immediately should hypoglycemia occur. Restarting patients on their regular hypoglycemic regimen will not likely create further harm. Am J Med 2002;113:232-4.