Basic Information
ID DDInter940 and DDInter809
Interaction Gatifloxacin may interfere with the therapeutic effects of insulin and other antidiabetic agents. The use of various quinolones has been associated with disturbances in blood glucose homeostasis possibly stemming from effects on pancreatic beta cell ATP-sensitive potassium channels that regulate insulin secretion.
Management The use of gatifloxacin is contraindicated in patients with diabetes mellitus. Other quinolones may be safer alternatives in such patients, although all quinolones should be used with caution. Blood glucose should be closely monitored whenever quinolones are prescribed to patients receiving insulin or other antidiabetic agents, especially if they are elderly or have renal impairment. Patients should learn to recognize the symptoms of hypoglycemia such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypo- or hyperglycemia occur during quinolone therapy, patients should initiate appropriate remedial therapy immediately, discontinue the antibiotic, and contact their physician.
References [1] Happe MR, Mulhall BP, Maydonovitch CL, Holtzmuller KC "Gatifloxacin-induced hyperglycemia." Ann Intern Med 141 (2004): 968-9 [2] Greenberg AL, Decerbo M, Fan J "Gatifloxacin therapy associated with hypoglycemia." Clin Infect Dis 40 (2005): 1210-1 [3] Park-Wyllie LY, Juurlink DN, Kopp A, et al. "Outpatient gatifloxacin therapy and dysglycemia in older adults." N Engl J Med 354 (2006): 1352-61 [4] "Hypoglycemia and hyperglycemia with fluoroquinolones." Med Lett Drugs Ther 45 (2003): 64 [5] Blommel AL, Lutes RA "Severe hyperglycemia during renally adjusted gatifloxacin therapy." Ann Pharmacother 39 (2005): 1349-52 [6] Gavin JR 3rd, Kubin R, Choudhri S, et al "Moxifloxacin and glucose homeostasis: a pooled-analysis of the evidence from clinical and postmarketing studies." Drug Saf 27 (2004): 671-86 [7] Zhanel GG, Fontaine S, Adam H, et al. "A Review of New Fluoroquinolones : Focus on their Use in Respiratory Tract Infections." Treat Respir Med 5 (2006): 437-465 [8] Rubinstein E "History of quinolones and their side effects." Chemotherapy 47 Suppl 3 (2001): 3-8 [9] Frothingham R "Glucose homeostasis abnormalities associated with use of gatifloxacin." Clin Infect Dis 41 (2005): 1269-76 [10] Tomita T, Onishi M, Sato E, Kimura Y, Kihira K "Gatifloxacin induces augmented insulin release and intracellular insulin." Biol Pharm Bull 30 (2007): 644-7 [11] Donaldson AR, Vandiver JR, Finch CK "Possible gatifloxacin-induced hyperglycemia." Ann Pharmacother 38 (2004): 602-5 [12] Bhasin R, Arce FC, Pasmantier R "Hypoglycemia associated with the use of gatifloxacin." Am J Med Sci 330 (2005): 250-3 [13] Gajjar DA, LaCreta FP, Kollia GD, et al. "Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise." Pharmacotherapy 20 (6 Pt 2) (2000): s76-86 [14] Menzies DJ, Dorsainvil PA, Cunha BA, Johnson DH "Severe and persistent hypoglycemia due to gatifloxacin interaction with oral hypoglycemic agents." Am J Med 113 (2002): 232-4 [15] Baker SE, Hangii MC "Possible gatifloxacin-induced hypoglycemia." Ann Pharmacother 36 (2002): 1722-6 [16] Graumlich JF, Habis S, Avelino RR, et al. "Hypoglycemia in inpatients after gatifloxacin or levofloxacin therapy: nested case-control study." Pharmacotherapy 25 (2005): 1296-302 [17] Letourneau G, Morrison H, McMorran M "Gatifloxacin (Tequin): hypoglycemia and hyperglycemia. Available from: URL: http://www.hc-sc.gc.ca/dhp-mps/medeff/bulletin/carn-bcei_v13n3_e.html#1" ([2003 Jul]): [18] Lin G, Hays DP, Spillane L "Refractory hypoglycemia from ciprofloxacin and glyburide interaction." J Toxicol Clin Toxicol 42 (2004): 295-7 [19] Saraya A, Yokokura M, Gonoi T, Seino S "Effects of fluoroquinolones on insulin secretion and beta-cell ATP-sensitive K(+) channels." Eur J Pharmacol 497 (2004): 111-7 [20] Roberge RJ, Kaplan R, Frank R, Fore C "Glyburide-ciprofloxacin interaction with resistant hypoglycemia." Ann Emerg Med 36 (2000): 160-3 [21] Brogan SE, Cahalan MK "Gatifloxacin as a possible cause of serious postoperative hypoglycemia." Anesth Analg 101 (2005): 635-6 [22] Khovidhunkit W, Sunthornyothin S "Hypoglycemia, hyperglycemia, and gatifloxacin." Ann Intern Med 141 (2004): 969 [23] LeBlanc M, Belanger C, Cossette P "Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy." Pharmacotherapy 24 (2004): 926-31 [24] Biggs WS "Hypoglycemia and hyperglycemia associated with gatifloxacin use in elderly patients." J Am Board Fam Pract 16 (2004): 455-7 [25] Yip C, Lee AJ "Gatifloxacin-induced hyperglycemia: a case report and summary of the current literature." Clin Ther 28 (2006): 1857-66 [26] Zvonar R "Gatifloxacin-induced dysglycemia." Am J Health Syst Pharm 63 (2006): 2087-2092 [27] "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ. [28] Skillman TG, Feldman JM "The pharmacology of sulfonylureas." Am J Med 70 (1981): 361-72 [29] "Product Information. Diabinese (chlorpropamide)." Pfizer US Pharmaceuticals, New York, NY. [30] "Product Information. Diabeta (glyburide)." Hoechst Marion-Roussel Inc, Kansas City, MO. [31] Jerntorp P, Almer LO, Holin H, et al "Plasma chlorpropamide: a critical factor in chlorpropamide-alcohol flush." Eur J Clin Pharmacol 24 (1983): 237-42 [32] Barnett AH, Spiliopoulos AJ, Pyke DA, et al "Metabolic studies in chlorpropamide-alcohol flush positive and negative type 2 (non-insulin dependent) diabetic patients with and without retinopathy." Diabetologia 24 (1983): 213-5 [33] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [34] Jerntorp P, Almer LO "Chlorpropamide-alcohol flushing in relation to macroangiopathy and peripheral neuropathy in non-insulin dependent diabetes." Acta Med Scand 656 (1981): 33-6 [35] "Product Information. Glucotrol (glipizide)." Pfizer US Pharmaceuticals, New York, NY. [36] "Position Statement: evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes related complications. American Diabetes Association." Diabetes Care 25(Suppl 1) (2002): S50-S60 [37] Hartling SG, Faber OK, Wegmann ML, Wahlin-Boll E, Melander A "Interaction of ethanol and glipizide in humans." Diabetes Care 10 (1987): 683-6 [38] "Product Information. Tequin (gatifloxacin)" Bristol-Myers Squibb, Princeton, NJ. [39] Wallace AW, Victory JM, Amsden GW "Lack of bioequivalence of gatifloxacin when coadministered with calcium-fortified orange juice in healthy volunteers." J Clin Pharmacol 43 (2003): 92-6
Alternative for Insulin lispro -
Alternative for Gatifloxacin S01A
Chloramphenicol Kanamycin Famciclovir Netilmicin Neomycin Ganciclovir
Ampicillin Amikacin Erythromycin Acyclovir Cefuroxime
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.