Drugs Xagena
Hydroxychloroquine ( Plaquenil ) is indicated for the treatment of rheumatoid arthritis, discoid and systemic lupus erythematosus, and malaria ( acute attacks and suppressive treatment ).
Hypoglycemia is generally defined by (a) the presence of symptoms consistent with hypoglycemia; (b) a low plasma glucose level ( the lower limit of the fasting plasma glucose level is normally approximately 3.9 mmol/L ); and (c) the relief of those symptoms after the plasma glucose level is raised.
Clinical manifestations of hypoglycemia include neuroglycopenic symptoms ( e.g., confusion, fatigue, seizure, loss of consciousness, and if hypoglycemia is severe and prolonged, death ) and neurogenic symptoms ( e.g., sweating, hunger, palpitations, trembling, anxiety, etc. ).
Hypoglycemia is rare in the absence of antidiabetic therapy.
The potential for Hydroxychloroquine to enhance the hypoglycemic effects of antidiabetic agents is known. As of Dec. 31, 2013, Health Canada received 2 reports of hypoglycemia suspected of being associated with Hydroxychloroquine. Both reports describe the reaction as occurring in the context of co-administration with Insulin or Metformin.
However, hypoglycemia involving Hydroxychloroquine without co-administration of a hypoglycemic agent has been reported in the literature.
There is sufficient evidence to support a causal association between Hydroxychloroquine use and the onset of hypoglycemia in this context, including serious cases involving a loss of consciousness and hospitalization.
Health care professionals should be aware of the association between hypoglycemia and Hydroxychloroquine, with or without the concomitant use of antidiabetic agents.
The Canadian product monograph for Plaquenil now includes the risk of hypoglycemia under the Warnings and Precautions section.
Patients treated with Hydroxychloroquine should be warned about the risk of hypoglycemia and the associated clinical signs and symptoms so that they may be recognized and addressed.
Patients presenting with symptoms suggestive of hypoglycemia should have their blood glucose level checked and the need for Hydroxychloroquine treatment reviewed as necessary.
In cases of severe hypoglycemia, Hydroxychloroquine treatment should be discontinued and an alternative therapy considered.
If patients use Hydroxychloroquine concomitantly with antidiabetic agents, a decrease in dose of insulin or antidiabetic drugs may be required. ( Xagena )
Source: Health Canada, 2014
XagenaMedicine_2014
