Drug General Information (ID: DDIQMP9N3V)
Drug Name			Norfloxacin		Drug Info		Insulin glulisine		Drug Info
Drug Type		Small molecule				Hormones
Therapeutic Class		Antibiotics				Antidiabetic Agents
Structure

Mechanism of Norfloxacin-Insulin glulisine Interaction (Severity Level: Major)
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Norfloxacin				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 Norfloxacin
Antagonize the effect of antidiabetic agents Click to Show/Hide Mechanism Graph
Drug Name		Norfloxacin				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 Norfloxacin
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 Norfloxacin

Recommended Action
Management		Blood glucose should be closely monitored whenever quinolones are prescribed to diabetic patients, especially if they are elderly, have renal impairment, or are severely ill. Due to the risk of profound and potentially life-threatening hypoglycemia, particular caution is advised during concomitant use of insulin and insulin secretagogues (e.g., sulfonylureas, meglitinides). Patients should also be apprised of the increased risk of hypoglycemia and be alert to potential signs and symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia. If hypoglycemia occurs, patients should initiate appropriate remedial therapy immediately, discontinue the quinolone, and contact their physician. alternative antibiotics may need to be considered.

References
1	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]
2	Product Information. Cipro (ciprofloxacin). Bayer, West Haven, CT.
3	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. [PMID: 15321742]