Hypoglycemic syncope induced by a combination of cibenzoline and angiotensin converting enzyme inhibitor

A 65-year-old Japanese woman with dilated cardiomyopathy, hypothyroidism an d refractory sustained ventricular tachycardia experienced a near-death hyp oglycemic syncope. The attack seemed to be induced by a high level of serum insulin, probably due to cibenzoline and by concomitant use of an angioten sin converting enzyme inhibitor (ACEI). Additionally, decreased food intake because of a severe toothache may have contributed to the deterioration of her condition. This case warns cardiologists that a combined cibenzoline a nd ACEI therapy can provoke serious adverse effects such as hypoglycemic sy ncope in the elderly. Therefore, the possibility of a hypoglycemic attack a ssociated with these drugs should be explained to patients who are in poor condition.