Sertraline-induced hypoglycemia

OBJECTIVE: To report a case of hypoglycemia that occurred in a patient trea ted with the selective serotonin-reuptake inhibitor, sertraline. CASE SUMMARY: An 82-year-old white woman with mild cardiovascular disease a nd no history of glucose intolerance was seen in the emergency department f or a presyncopal episode associated with a blood glucose of 32 mg/dL as mea sured by the ambulance attendant. She had similar symptoms the day before. Despite repeated administration of oral and intravenous glucose, the patien t had recurrent episodes of hypoglycemia and was hospitalized for four days . She had started taking sertraline 50 mg once daily for mild depression 25 days prior to presentation. Other medications included furosemide 20 mg/d, ramipril 5 mg/d, clopidogrel 75 mg/d, nitroglycerin patch 0.4 mg/h, and lo razepam 1 mg taken occasionally for agitation. She had never been prescribe d any oral hypoglycemic agents. Serum sertraline and desmethylsertraline co ncentrations measured two, three, and four days after discontinuing sertral ine were within the expected range, but the rate of decline was consistent with a moderately prolonged half-time. DISCUSSION: Sertraline has been shown to blunt postprandial hyperglycemia i n rats and to potentiate the hypoglycemic effects of sulfonylurea agents in humans. It has not been reported to cause hypoglycemia independently, but in this case, a nondiabetic patient experienced multiple episodes of hypogl ycemia that resolved after discontinuation of sertraline.