Can Cipramil (citalopram), Tenormin (atenolol) or allopurinol cause hypoglycemia?/nA 72-year-old no

Fråga: Can Cipramil (citalopram), Tenormin (atenolol) or allopurinol cause hypoglycemia?

A 72-year-old non-diabetic woman was hospitalised due to seizures judged to be caused by hypoglycemia. She had been treated with the above mentioned drugs for a long period of time in unknown doses.

Follow up: When the telephone answer was given complimentary information was provided. Thus, the patient is also treated with the following drugs; Dexodon (dextropropoxyphene), Theralen (alimemazine), Distalgesic (dextropropoxyphene), Losec (omeprazole), Lunerin (phenylpropanolamine), Trombyl (acetylsalicylic acid), Mucomyst (acetylcysteine), Lactulos and Astratonil.

Sammanfattning: It is concluded that atenolol and citalopram but not allopurinol have been associated with hypoglycemia on the basis of a small number of case reports.

Svar: The occurrence of drug-induced hypoglycemia in non-diabetic patients is rare and the risks of spontaneous and drug-induced hypoglycemia are increased in the presence of renal and liver disease.

Hypoglycemia can occur in non-diabetic patients after treatment with non-selective blocking agents such as propranolol (1,2) and it results from a combination of enhanced activity of circulating insulin through inhibition of peripheral lipolysis, hepatic phosphorylation, and facilitation of peripheral glucose uptake (1).

Documentation of atenolol-induced hypoglycemia is sparse. However, one report of atenolol-overdose resulting in hypoglycemia has been described (3) and the database Swedis contains one report to the Swedish Adverse Drug Reactions Advisory Committee (SADRAC), where a non-diabetic 71-year-old patient had symptoms such as aggression, desorientation, nightmares and visual hallucinations. Blood glucose was measured to 2.0 mmol/L. The patient recovered after withdrawal and a contributing factor in this case was decreased kidney function.

Citalopram has been associated with hypoglycemia (4), but the mechanism through which hypoglycemia is induced is not fully understood. SADRAC has received two reports of hypoglycemia during treatment with citalopram. One of the reports concerned a non-diabetic patient. No further information of this case is known.

No information has been found in the literature concerning hypoglycemia induced by allopurinol. 1 Chan JCN, Cockram. Disorders of metabolism 1. Hypoglycemia. In: Davies DM, editor. Textbook of adverse drug reactions. 4th ed. Oxford University Press; 1991. p. 383 2 Drugline no 02480 (year 1981) 3 Abbasi IA, Sorsby S: Prolonged toxicity from atenolol overdose in an adolescent. Clin Pharmacy 1986; 5: 836-7 4 Drugline no 14409 (year 1997)