title: Hypoglycemia secondary to trimethoprim/sulfamethoxazole administration in a renal transplant patient.
abstract: OBJECTIVE
  To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycemia in an immunosuppressed renal transplant patient.
  
  
  METHODS
  English-language journal articles and reference texts identified via a MEDLINE search and a bibliographic review of pertinent data sources.
  
  
  RESULTS
  Hypoglycemia resulting from the combination of sulfonylureas and sulfonamides is a recognized drug interaction. Hypoglycemia induced by sulfonamides alone may be encountered less frequently. Previously reported cases of TMP/SMX-induced hypoglycemia postulated that the sulfonamide mimics hypoglycemic sulfonylurea agents and stimulates pancreatic islet cells to secrete insulin. We report a case of hypoglycemia following the administration of high-dose TMP/SMX in a renal transplant patient. Elevated C-peptide concentrations following the hypoglycemic episode indicate that hypoglycemia resulted from increased endogenous insulin secretion.
  
  
  CONCLUSIONS
  Hypoglycemia has been a rarely encountered result of TMP/SMX use. Patients receiving TMP/SMX, particularly those with impaired renal function and those receiving high doses, should be monitored closely for hypoglycemia.
authors.affiliation: College of Pharmacy, University of Saskatchewan, Saskatoon, Canada.
authors.forename: J A
authors.initials: JA
authors.lastname: Johnson
authors.forename: J E
authors.initials: JE
authors.lastname: Kappel
authors.forename: M N
authors.initials: MN
authors.lastname: Sharif
mesh_terms: D000328:Adult; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D016030:Kidney Transplantation; D008297:Male; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D015662:Trimethoprim, Sulfamethoxazole Drug Combination