title: Linezolid-associated hypoglycemia in a 64-year-old man with type 2 diabetes.
abstract: BACKGROUND
  Older diabetic patients are at increased risk for skin infections, often with methicillin-resistant Staphylococcus aureus (MRSA). Linezolid offers oral therapy with MRSA coverage. We present a case of linezolid-associated hypoglycemia in a 64-year-old diabetic patient with presumed MRSA cellulitis.
  
  
  METHODS
  A 64-year-old man with diabetes was treated for cellulitis. Linezolid was started when amoxicillin/clavulanate failed. Within 7 days, he developed frequent diaphoresis and tremulousness, with glucoses of 30 to 60 mg/dL. Hypoglycemia worsened despite decreasing insulin use, discontinuing glyburide, and increasing caloric intake. The day of admission, he awoke with a glucose level of 30 mg/dL. He took no medications, ate a large breakfast, and presented to clinic. He was symptomatic with a glucose level of 35 mg/dL. Hypoglycemia persisted despite IV dextrose. Linezolid was discontinued immediately in favor of vancomycin. Dextrose was weaned and his diabetes medications were resumed without further hypoglycemia.
  
  
  CONCLUSIONS
  Linezolid has monoamine oxidase (MAO) inhibitory properties, and MAO inhibitors have been reported to contribute to hypoglycemia. The use of linezolid in older diabetic patients, especially those patients already taking agents with the potential to cause hypoglycemia, represents an area of concern. Increased comorbidities and polypharmacy in geriatric patients adds to this concern.
authors: Department of Internal Medicine, Division of Geriatric Medicine and Geriatrics Center, Medical School, University of Michigan, Ann Arbor, Michigan 48109-2007, USA.
authors: Timothy
authors: T
authors: Bodnar
authors: Katelyn
authors: K
authors: Starr
authors: Jeffrey B
authors: JB
authors: Halter
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects*; D002481:Cellulitis / Q000097:blood / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000069349:Linezolid; D008297:Male; D008875:Middle Aged; D023303:Oxazolidinones / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000081:Acetamides; D007004:Hypoglycemic Agents; D023303:Oxazolidinones; D000069349:Linezolid