Tequin and Dysglycemia

The use of gatifloxacin is contraindicated in patients with diabetes mellitus. Treatment with various quinolones has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion. However, dysglycemia has been reported more frequently with gatifloxacin than with other quinolones. Although typically reported in diabetic patients, hypoglycemia and particularly hyperglycemia have occurred in patients without a history of diabetes. Gatifloxacin-induced hypoglycemic episodes have generally occurred within the first 3 days of therapy and sometimes even after the first dose, while hyperglycemia usually occurred 4 to 10 days after initiation of therapy. Serious cases have resulted in hyperosmolar nonketotic hyperglycemic coma, diabetic ketoacidosis, hypoglycemic coma, convulsions, and mental status changes. Rarely, death has been reported. In addition to diabetes, other risk factors associated with dysglycemia while taking gatifloxacin include older age, renal insufficiency, and concomitant glucose-altering mediations. Patients with these risk factors should be closely monitored for glucose disturbances. Dosage adjustments may be necessary, particularly in elderly patients who may have unrecognized diabetes, age-related decrease in renal function, and/or other underlying medical problems. The manufacturer recommends a dosage reduction to 200 mg/daily after an initial dose of 400 mg in patients with creatinine clearance below 40 mL/min. Patients should be counseled to recognize symptoms of hypoglycemia such as headache, dizziness, drowsiness, nausea, tremor, weakness, hunger, excessive perspiration, and palpitations. If hypo- or hyperglycemia occur during therapy, patients should initiate appropriate remedial therapy immediately, discontinue the antibiotic, and contact their physician.