MEFLOQUINE-ASSOCIATED HYPOGLYCEMIA IN A CACHECTIC AIDS PATIENT

Quinine and its isomer quinidine are well-known causes of iatrogenic h ypoglycaemia, due to excessive insulin secretion. The situation is les s clear regarding other anti-malarial quinine analogues. In particular , this adverse effect has never been described with mefloquine (Lariam (R)). We report a case of hypoglycaemia after mefloquine therapy (1 50 0 mg over two days) for severe gastrointestinal cryptosporidiasis in a cachectic AIDS patient with protracted diarrhoea. Blood glucose level s, which were normal before treatment, dropped to 2.3 mmol/l within a few hours and were corrected by IV glucose infusion. Hypoglycaemia did not recur despite continued treatment. Rat islets of Langerhans expos ed to mefloquine in vitro (10(-8) mol/l to 10(-3) mol/l) secreted sign ificantly more insulin than control islets (up to 980 +/- 180 mu U/ml/ 5 islets incubated with mefloquine 10(-3) mol/l, vs 20 +/- 4 mu U/ml/5 untreated islets). Mechanisms and triggering factors of hypoglycaemia induced by mefloquine and some other anti-malarial quinine analogues are discussed. Clinicians who manage cachectic patients, particularly those with protracted diarrhoea and/or receiveing anti-malarial drugs including mefloquine, should be aware of the risk of severe hypoglycae mia.