Hypoglycemic syncope induced by a combination of cibenzoline and angiotensin converting enzyme inhibitor.
A 65-year-old Japanese woman with dilated cardiomyopathy, hypothyroidism and refractory sustained ventricular tachycardia experienced a near-death hypoglycemic syncope. The attack seemed to be induced by a high level of serum insulin, probably due to cibenzoline and by concomitant use of an angiotensin converting enzyme inhibitor (ACEI). Additionally, decreased food intake because of a severe toothache may have contributed to the deterioration of her condition. This case warns cardiologists that a combined cibenzoline and ACEI therapy can provoke serious adverse effects such as hypoglycemic syncope in the elderly. Therefore, the possibility of a hypoglycemic attack associated with these drugs should be explained to patients who are in poor condition.
Ogimoto
A
A
Second Department of Internal Medicine, Ehime University School of Medcine, Japan.
Hamada
M
M
Saeki
H
H
Hiasa
G
G
Ohtsuka
T
T
Hashida
H
H
Hara
Y
Y
Okura
T
T
Shigematsu
Y
Y
Hiwada
K
K
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007037:Hypothyroidism / Q000188:drug therapy; D007093:Imidazoles / Q000009:adverse effects*; D013575:Syncope / Q000139:chemically induced*; D017180:Tachycardia, Ventricular / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D007093:Imidazoles; C032151:cifenline