title: Clinical review: Drug-induced hypoglycemia: a systematic review.
abstract: BACKGROUND
  Drug-induced hypoglycemia is a significant adverse effect that may cause important morbidity.
  
  
  OBJECTIVE
  The aim of the study was to systematically review the literature for drugs reported to cause hypoglycemia and assess the quality of evidence and strength of association supporting this causal link.
  
  
  METHODS
  We searched electronic databases (MEDLINE, EMBASE, Web of Science, and SCOPUS) and the drug information system Micromedex through November 2007 and sought additional references from experts.
  
  
  METHODS
  Studies were eligible if they reported hypoglycemia as a side effect of a drug not used to treat hyperglycemia, regardless of their design, language, size, or follow-up duration. We excluded hypoglycemia caused by industrial exposures, nonpharmacological chemical exposures, alcohol, herbs, nutritional supplements, and in vitro and animal studies.
  
  
  METHODS
  Reviewers extracted study characteristics and methodological quality and, when possible, data to estimate the odds of developing hypoglycemia when exposed to the offending agent.
  
  
  RESULTS
  We found 448 eligible studies that described 2696 cases of hypoglycemia associated with 164 different drugs. The quality of evidence supporting associations between drugs and hypoglycemia was mostly very low due to methodological limitations and imprecision. The most commonly reported offending drugs were quinolones, pentamidine, quinine, beta blockers, angiotensin-converting enzyme agents, and IGF.
  
  
  CONCLUSIONS
  Very low quality evidence substantiates the association between hypoglycemia and the use of numerous nondiabetic drugs.
authors.affiliation: Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Fernando
authors.initials: F
authors.lastname: Coto-Yglesias
authors.forename: Amy T
authors.initials: AT
authors.lastname: Wang
authors.forename: Nasim
authors.initials: N
authors.lastname: Sheidaee
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mullan
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elamin
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged