Abstract
Ciprofloxacin, a fluoroquinolone widely used for the treatment of bacterial infections, is associated with episodes of severe hypoglycemia. Although this condition is a class effect observed with various quinolones, ciprofloxacin is considered one of the lower-risk options, with a stronger correlation in the presence of other risk factors, particularly diabetes and the use of hypoglycemic medications. In the absence of these characteristics, its association is less prevalent. This paper aims to report the case of an elderly, non-diabetic patient not using hypoglycemic medications who developed episodes of hypoglycemia associated with ciprofloxacin use.
References
BERHE, A.; RUSSOM, M.; BAHRAN, F.; HAGOS, G. Ciprofloxacin and risk of hypoglycemia in non-diabetic patients. *Journal of Medical Case Reports*, v. 13, n. 1,
p. 142, 2019. DOI: 10.1186/s13256-019-2083-y. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/31078137/. Acesso em: 25 ago. 2024.
ASPINALL, S. L.; GOOD, C. B.; JIANG, R.; MCCARREN, M.; DONG, D.;
CUNNINGHAM, F. E. Severe dysglycemia with the fluoroquinolones: a class effect?
*Clinical Infectious Diseases*, v. 49, n. 3, p. 402-408, 2009. DOI: 10.1086/600294. Disponível em: https://pubmed.ncbi.nlm.nih.gov/19545207/. Acesso em: 25 ago. 2024.
CHOU, H. W. et al. Risk of severe dysglycemia among diabetic patients receiving levofloxacin, ciprofloxacin, or moxifloxacin in Taiwan. *Clinical Infectious Diseases*, v. 57, n. 7, p. 971-980, 2013. DOI: 10.1093/cid/cit439. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/23948133/. Acesso em: 25 ago. 2024.
SINGH, P. et al. Ciprofloxacin-Associated Hypoglycemia. *American Journal of Therapeutics*, v. 26, n. 6, p. e717-e718, 2019. DOI: 10.1097/MJT.0000000000000867. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/31710316/. Acesso em: 25 ago. 2024.
PARK-WYLLIE, L. Y. et al. Outpatient gatifloxacin therapy and dysglycemia in older adults. *New England Journal of Medicine*, v. 354, n. 13, p. 1352-1361, 2006. DOI: 10.1056/NEJMoa055191. Disponível em: https://pubmed.ncbi.nlm.nih.gov/16510739/. Acesso em: 25 ago. 2024.
MATOI, A.; TAGUCHI, M.; NISHI, S. Fatal hypoglycemia with ciprofloxacin in a dialysis patient: A case report. *Clinical Case Reports*, v. 9, n. 4, p. 1902-1904, 2021. DOI: 10.1002/ccr3.3871. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33936612/. Acesso em: 25 ago. 2024.
OWENS, R. C. Jr.; AMBROSE, P. G. Antimicrobial safety: focus on fluoroquinolones.
*Clinical Infectious Diseases*, v. 41, supl. 2, p. S144-S157, 2005. DOI: 10.1086/428055. Disponível em: https://pubmed.ncbi.nlm.nih.gov/15942881/. Acesso em: 25 ago. 2024.
LIAO, S. H. et al. Risk for hypoglycemic emergency with levofloxacin use, a population- based propensity score matched nested case-control study. *PLoS One*, v. 17, n. 4, e0266471, 2022. DOI: 10.1371/journal.pone.0266471. Disponível em: https://pubmed.ncbi.nlm.nih.gov/35377912/. Acesso em: 25 ago. 2024.
MOHR, J. F. et al. A Retrospective, Comparative Evaluation of Dysglycemias in Hospitalized Patients Receiving Gatifloxacin, Levofloxacin, Ciprofloxacin, or Ceftriaxone. *Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy*, v. 25, p. 1303-1309, 2005. DOI: 10.1592/phco.2005.25.10.1296. Disponível em: https://doi.org/10.1592/phco.2005.25.10.1296. Acesso em: 25 ago. 2024.
MURAD, M. H. et al. Clinical review: Drug-induced hypoglycemia: a systematic review.
*Journal of Clinical Endocrinology and Metabolism*, v. 94, n. 3, p. 741-745, 2009. DOI: 10.1210/jc.2008-1416. Disponível em: https://pubmed.ncbi.nlm.nih.gov/19088166/. Acesso em: 25 ago. 2024.
GRAUMLICH, J. F. et al. Hypoglycemia in Inpatients After Gatifloxacin or Levofloxacin Therapy: Nested Case-Control Study. *Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy*, v. 25, p. 1296-1302, 2005. DOI: 10.1592/phco.2005.25.10.1296. Disponível em: https://doi.org/10.1592/phco.2005.25.10.1296. Acesso em: 25 ago. 2024.
LODISE, T. et al. Effects of Gatifloxacin and Levofloxacin on Rates of Hypoglycemia and Hyperglycemia Among Elderly Hospitalized Patients. *Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy*, v. 27, p. 1498-1505, 2007. DOI: 10.1592/phco.27.11.1498. Disponível em: https://doi.org/10.1592/phco.27.11.1498. Acesso em: 25 ago. 2024.
SCHELLEMAN, H. et al. Anti-infectives and the risk of severe hypoglycemia in users of glipizide or glyburide. *Clinical Pharmacology & Therapeutics*, v. 88, n. 2, p. 214- 222, 2010. DOI: 10.1038/clpt.2010.74. Disponível em:
https://pubmed.ncbi.nlm.nih.gov/20592722/. Acesso em: 25 ago. 2024.
ELLIS, D. E. et al. Comparative risk of serious hypoglycemia among persons dispensed a fluoroquinolone versus a non-fluoroquinolone antibiotic. *Diabetes Research and Clinical Practice*, v. 185, 2022. DOI: 10.1016/j.diabres.2022.109225. Disponível em: https://doi.org/10.1016/j.diabres.2022.109225. Acesso em: 25 ago. 2024.
MEHLHORN, A. J.; BROWN, D. A. Safety concerns with fluoroquinolones. *Annals of Pharmacotherapy*, v. 41, n. 11, p. 1859-1866, 2007. DOI: 10.1345/aph.1K347. Disponível em: https://pubmed.ncbi.nlm.nih.gov/17911203/. Acesso em: 25 ago. 2024.
MANDAVIA, D. R. et al. Moxifloxacin-induced hypoglycemia in a non-diabetic patient.
*Current Drug Safety*, v. 7, n. 2, p. 183-185, 2012. DOI: 10.2174/157488612802715744. Disponível em: https://pubmed.ncbi.nlm.nih.gov/22873504/. Acesso em: 25 ago. 2024.
GIBERT, A. E.; PORTA, F. S. Hypoglycemia and levofloxacin: a case report. *Clinical Infectious Diseases*, v. 46, p. 1126-1127, 2008. Disponível em:
https://doi.org/10.1086/527384. Acesso em: 25 ago. 2024.
SINGH, N.; JACOB, J. J. Levofloxacin and hypoglycemia. *Clinical Infectious Diseases*, v. 46, p. 1127, 2008. Disponível em: https://doi.org/10.1086/527385.
Acesso em: 25 ago. 2024.
MAEDA, N. et al. Increase in insulin release from rat pancreatic islets by quinolone antibiotics. *British Journal of Pharmacology*, v. 117, n. 2, p. 372-376, 1996. DOI: 10.1111/j.1476-5381.1996.tb15201.x. Disponível em: https://pubmed.ncbi.nlm.nih.gov/8789393/. Acesso em: 25 ago. 2024.
SARAYA, A. et al. Effects of fluoroquinolones on insulin secretion and beta-cell ATP- sensitive K+ channels. *European Journal of Pharmacology*, v. 497, n. 1, p. 111-117, 2004. DOI: 10.1016/j.ejphar.2004.06.032. Disponível em: https://pubmed.ncbi.nlm.nih.gov/15321742/. Acesso em: 25 ago. 2024.
GHALY, H. et al. The insulinotropic effect of fluoroquinolones. *Biochemical Pharmacology*, v. 77, n. 6, p. 1040-1052, 2009. DOI: 10.1016/j.bcp.2008.11.019.
Disponível em: https://pubmed.ncbi.nlm.nih.gov/19073153/. Acesso em: 25 ago. 2024.
GAJJAR, D. A. et al. Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise. *Pharmacotherapy*, v. 20, n. 6 pt 2, p. 76S- 86S, 2000. DOI: 10.1592/phco.20.8.76s.35182. Disponível em: https://pubmed.ncbi.nlm.nih.gov/10850524/. Acesso em: 25 ago. 2024.
ROBERGE, R. J. et al. Glyburide-ciprofloxacin interaction with resistant hypoglycemia.
*Annals of Emergency Medicine*, v. 36, n. 2, p. 160-163, 2000. DOI: 10.1067/mem.2000.108617. Disponível em: https://pubmed.ncbi.nlm.nih.gov/10918110/. Acesso em: 25 ago. 2024.
NARANJO, C. A. et al. A method for estimating the probability of adverse drug reactions. *Clinical Pharmacology and Therapeutics*, v. 30, n. 2, p. 239-245, 1981. DOI: 10.1038/clpt.1981.154. Disponível em: https://pubmed.ncbi.nlm.nih.gov/7249508/. Acesso em: 25 ago. 2024.
FOOD AND DRUG ADMINISTRATION. FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. Disponível em: https://www.fda.gov/newsevents/press-announcements/fda-updates-warnings- fluoroquinolone-antibiotics-risks-mental-healthand-low-blood-sugar-adverse. Acesso em: 25 ago. 2024.

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