Hyperlactatemia can be caused by medications through a variety of mechanisms.
Mechanisms of drug-induced hyperlactatemia:
(1) increased pyruvate production
(2) production of lactate (from propylene glycol, from lactated Ringer's solution
(3) inhibition of mitochrondrial enzymes (affecting protein synthesis, electron transport chain, uncoupling of oxidative phosphorylation)
(4) interference with the Cori cycle
Increased pyruvate production:
(1) high doses of beta-2-agonists
Drugs containing propylene glycol:
(1) lorazepam
(2) phenobarbital
(3) diazepam
(4) digoxin
(5) hydralazine
(6) phenytoin
(7) trimethoprim/sulfamethoxazole
(8) etomidate
(9) nitroglycerin
(10) esmolol
(11) chlorpromazine
Drugs that inhibit various mitochondrial functions:
(1) propofol
(2) salicylates
(3) barbiturates
(4) valproic acid (VPA)
(5) desipramine
(6) amitriptyline
(7) imipramine
(8) citalopram
(9) mirtazapine
(10) olanzapine
(11) venlazafine
(12) oxazolidinones
(13) NRTI (nucleoside reverse transcriptase inhibitor)
(14) sodium nitroprusside (SNP)
Drugs that interfere with the Cori cycle:
(1) phenformin
(2) metformin
