Pharmacy Services

Quinolones and Blood Glucose Abnormalities (Hypoglycemia, Hyperglycemia) & Gatifloxacin (Tequin) and Blood Glucose Abnormalities/Contraindicated in Diabetics

June 26, 2009

Dysregulation of blood glucose has been noted with all the available fluoroquinolones (ie, ciprofloxacin [Cipro], gatifloxacin [Tequin], gemifloxacin [Factive], levofloxacin [Levaquin], lomefloxacin [Maxaquin], moxifloxacin [Avelox], norfloxacin [Noroxin], ofloxacin [Floxin]), including some fatalities. Hyperglycemia has been reported with all the available fluoroquinolones. Hypoglycemia has also been reported with every agent but gemifloxacin (Factive), the newest agent. The quinolones increase insulin release from pancreatic islet cells as a class, therefore caution may be warranted with all quinolone antibiotics.

Based on postmarketing data, disturbances in blood glucose may be more common with gatifloxacin than with other fluoroquinolones. In February 2006, the FDA and Bristol-Myers Squibb revised the gatifloxacin product labeling to reflect this increased risk. Gatifloxacin will be contraindicated in diabetic patients when the changes are finalized. Other changes to the product labeling included additional information about risk factors for blood glucose abnormalities and additional monitoring recommendations. Risk may be increased in patients receiving concomitant therapy with hypoglycemic agents, elderly patients, or patients with renal dysfunction. In May 2006, Bristol-Myers Squibb discontinued marketing of gatifloxacin.

The following are reasonable actions to help prevent and manage quinolone-induced hypoglycemia.

Check the patient's age, diabetic status, and renal function. If patient is elderly, has renal dysfunction, or is diabetic, consider other antibiotic therapy. Avoid gatifloxacin use in diabetic patients.
Consider that the hypoglycemia may be drug-induced in any patient who develops hypoglycemic symptoms while on quinolone therapy. The reaction often occurs after the first dose and may persist until fluoroquinolone discontinuation.
Please report any adverse events involving quinolones that you find. At University HealthCare, this may be done by using the web-based Patient Safety Net tool (icon is on all UHC patient care area workstations) or by calling the Drug Information Service at 801-581-2073.

Additional information is available online at the following links:

FDA Medwatch Alert:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150760.htm
Dear Healthcare Provider letter:
http://www.fda.gov/downloads/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/UCM153428.pdf
Gatifloxacin discontinuation notice:
http://intranet.uuhsc.utah.edu/pharmacy/shortages/tequin_discontinued.pdf
Postmarketing analysis of FDA adverse drug event database, published in Clin Infect Dis. 2005;41(9):1269-1276.:
http://www.journals.uchicago.edu/CID/journal/issues/v41n9/37026/37026.web.pdf (access restricted to subscribers or University of Utah Campus)

References

Anonymous. Hypoglycemia and Hyperglycemia with Fluoroquinolones. The Medical Letter 2003; 1162: 64.
LeTourneau G, Morrison H, McMorran M. Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. Canadian Adverse Reaction Newsletter. July 2003;13(3):1-2.
Frothingham R. Glucose homeostasis abnormalities associated with use of gatifloxacin. Clin Infect Dis. Nov 1 2005;41(9):1269-1276.

Updated
June 26, 2009; February 17, 2006; University of Utah, Drug Information Service. Copyright 2009, Drug Information Service, University of Utah, Salt Lake City, UT.