title: Severe and protracted hypoglycaemia associated with co-trimoxazole use.
abstract: Co-trimoxazole (trimethoprim-sulfamethoxazole) is a commonly prescribed antimicrobial agent. Although it is well tolerated in most patients, serious adverse events related to its use have been described. Hypoglycaemia is a rare but potentially life-threatening complication of therapy. We describe a case of refractory hypoglycaemia complicated by seizure associated with co-trimoxazole for the treatment of Pneumocystis carinii pneumonia in a patient with AIDS. We also review 13 previously reported cases of co-trimoxazole-induced hypoglycaemia. Among this patient population, renal insufficiency was the most prevalent predisposing risk factor (93%). The mean daily dose of co-trimoxazole was 4.5 double strength (160 mg trimethoprim/800 mg sulfamethoxazole) tablets per day. Serum insulin levels were raised or inappropriately normal in 88% of cases in which they were measured, suggesting a sulfonylurea-like effect of co-trimoxazole as the mechanism of hypoglycaemia. All cases required intravenous glucose administration, and 43% experienced protracted (>12 hours) hypoglycaemia. Dosage adjustments should be made when prescribing co-trimoxazole to patients with renal dysfunction.
authors.affiliation: University of Toronto, Toronto, Canada.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Strevel
authors.forename: Ayelet
authors.initials: A
authors.lastname: Kuper
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Gold
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007223:Infant; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy*; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology
chemical_list: D000935:Antifungal Agents; D007328:Insulin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D005947:Glucose