Drug General Information (ID: DDI4G7TXBO)
Drug Name			Gatifloxacin		Drug Info		Insulin glulisine		Drug Info
Drug Type		Small molecule				Hormones
Therapeutic Class		Antiinfective Agents				Antidiabetic Agents
Structure

Mechanism of Gatifloxacin-Insulin glulisine Interaction (Severity Level: Major)
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Gatifloxacin				Insulin glulisine
Mechanism 1		Hypoglycemic effects				Antidiabetic agent
Key Mechanism Factor 1
		Factor Name		Hypoglycemia
		Factor Description		Hypoglycemia is a condition in which your blood sugar (glucose) level is below the standard range. It causes irregular or rapid heartbeat, pale skin, numbness of the lips, tongue or cheeks, and sweating.
Mechanism Description		Increased risk of hypoglycemia by the combination of Insulin glulisine and Gatifloxacin
Antagonize the effect of antidiabetic agents Click to Show/Hide Mechanism Graph
Drug Name		Gatifloxacin				Insulin glulisine
Mechanism 2		Hyperglycemia				Antidiabetic agent
Key Mechanism Factor 2
		Factor Name		Antidiabetic agents
		Factor Description		The hypoglycemic effect of antidiabetes may be reduced, leading to higher blood glucose, increased blood glucose fluctuations, and the possibility of hyperglycemic complications
Mechanism Description		Antagonize the effect of Insulin glulisine when combined with Gatifloxacin
Mechanism 3		Hyperglycemic effects				Antidiabetic agent
Key Mechanism Factor 3
		Factor Name		Antidiabetic agents
		Factor Description		The hypoglycemic effect of antidiabetes may be reduced, leading to higher blood glucose, increased blood glucose fluctuations, and the possibility of hyperglycemic complications
Mechanism Description		Antagonize the effect of Insulin glulisine when combined with Gatifloxacin

Recommended Action
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	Greenberg AL, Decerbo M, Fan J "Gatifloxacin therapy associated with hypoglycemia." Clin Infect Dis 40 (2005): 1210-1. [PMID: 15791528]
2	Happe MR, Mulhall BP, Maydonovitch CL, Holtzmuller KC "Gatifloxacin-induced hyperglycemia." Ann Intern Med 141 (2004): 968-9. [PMID: 15611500]
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. [PMID: 16510739]