Drugs other than insulin and the oral hypoglycemic agents (sulfonylureas, thiazolidinedione, metformin, meglitinide, alpha-glucosidase inhibitors) may be associated with hypoglycemia.


Possible mechanisms: increased release of insulin. increased insulin sensitivity, masking of hypoglycemic symptoms, decreased hepatic gluconeogenesis, decreased glucose absorption


Drugs causing hypoglycemia during an overdose:

(1) aspirin (especially in children)

(2) lidocaine

(3) acetaminophen (with hepatic necrosis)


Drugs that may induce hypoglycemia in patients:

(1) nonselective beta-blockers

(2) sulfamethoxyzole (similar to sulfonylurea)

(3) quinine

(4) pentamidine (early after exposure, followed later by hyperglycemia)

(5) beta-2 agonists

(6) disopyramide

(7) ethanol

(8) monoamine oxidase inhibitors

(9) tricyclic antidepressants

(10) angiotensin-converting enzyme (ACE) inhibitors

(11) alpha blocking agents

(12) clofibrate and other fibric acid derivatives

(13) octreotide

(14) lithium (in non-insulin dependent diabetics)

(15) cibenzoline

(16) quinidine

(17) propoxyphene

(18) mebendazole

(19) tetracyclines

(20) stanazolol

(21) fluoroquinolone antibiotics


The presence of two or more of these agents may cause hypoglycemia when a smaller number does not.


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