Ciprofloxacin and Risk of Hypoglycemia in Non-diabetic Patients

Abiel Berhe; Mulugeta Russom; Fithawit Bahran; Goitom Hagos


J Med Case Reports. 2019;13(142) 

In This Article


Fluoroquinolones, the commonly used antibacterials, have been associated with dysglycemia (hypoglycemia and/or hyperglycemia) mainly in patients with diabetes taking either oral hypoglycemic agents or insulin.[1] Most of the patients who developed hypoglycemia following fluoroquinolone use had risk factors such as old age, diabetes, renal insufficiency, and concomitant use of hypoglycemic drugs, especially sulfonylureas.[2–4]

An observational study reported an increased risk of dysglycemia with the use of fluoroquinolones in both patients with diabetes and patients without diabetes.[5] In that study, unlike with other fluoroquinolones, no cases of hypoglycemia were reported with the use of ciprofloxacin, though several cases of hyperglycemia were documented. A systematic review[6] and a retrospective cohort study[7] reported a higher risk of hypoglycemia associated with gatifloxacin but not with ciprofloxacin that resulted in gatifloxacin being pulled from the U.S. market.[2] Besides, in published case reports, levofloxacin has been associated with hypoglycemia, including death.[8,9] In addition, on July 10, 2018, the U.S. Food and Drug Administration (FDA), in its review of postmarket pharmacovigilance data, communicated a safety alert on fluoroquinolones and risk of hypoglycemia.[10]

The summary of product characteristics of ciprofloxacin registered with the FDA,[9] European Medicines Agency,[10] and Medicines and Healthcare Products Regulatory Activities[11] documents hypoglycemia as an adverse effect in patients with diabetes, possibly due to drug-drug interaction[11–13] or hyperinsulinemia.[14] In all cases, hypoglycemia abated shortly following withdrawal of ciprofloxacin. There was also a published case report of hypoglycemia following use of ciprofloxacin in an elderly patient without diabetes who had renal failure that immediately improved following withdrawal of the drug.[15] To the best of the authors' knowledge, ciprofloxacin has not been associated with hypoglycemia in young, healthy patients without diabetes.

Recently, the Eritrean National Pharmacovigilance Centre received a serious case with recurrent episodes of hypoglycemia in a young, previously healthy patient without diabetes following use of oral ciprofloxacin. The aim of the present study therefore was to assess the causal relationship between ciprofloxacin and hypoglycemia in patients without diabetes using the World Health Organization (WHO) global adverse drug reaction database (VigiBase®).