Department of Medicine, School of Medicine, Southern Illinois University, 701 N. First St., PO Box 19636, Springfield, IL 62794, USA.
Ann Pharmacother. 2010 Feb;44(2):387-90. doi: 10.1345/aph.1M433. Epub 2010 Jan 5.
To report the safe use of subcutaneous octreotide in the treatment of sulfonylurea-induced hypoglycemia in 2 patients with severe congestive heart failure.
Two patients with congestive heart failure with systolic dysfunction presented with severe hypoglycemia (blood glucose level: patient 1, 31 mg/dL; patient 2, 36 mg/dL) secondary to sulfonylurea agents. The mechanism of hypoglycemia was poor oral intake and prolonged half-life of the drugs due to renal failure. Hypoglycemia was refractory to glucose supplementation. Patient 1 received 2 doses of octreotide 50 microg subcutaneously 12 hours apart, with resolution of hypoglycemia (blood glucose level: <33 mg/dL before administration of octreotide, 62 mg/dL after first dose, 121 mg/dL after second dose). Patient 2 received an initial dose of octreotide 25 microg subcutaneously; hypoglycemia persisted after this dose, and the patient was given 2 doses of 50 microg subcutaneously 12 hours apart, leading to resolution of hypoglycemia (blood glucose level: 57 mg/dL before administration of octreotide, 80 mg/dL after first dose, 85 mg/dL after second dose, 146 mg/dL after third dose). Resolution of hypoglycemia with octreotide treatment obviated the need for prolonged intravenous dextrose infusions. No local or systemic adverse effects, especially cardiac adverse events, were noted during the course of treatment.
Octreotide is considered the antidote for sulfonylurea-induced hypoglycemia. It may be especially useful in patients with congestive heart failure who may not tolerate intravenous infusions of dextrose. The package insert cautions of the occurrence of cardiac adverse effects such as bradycardia, heart block, and worsening heart failure. Patients with heart failure may theoretically be at a higher risk of these adverse effects due to the concurrent use of atrioventricular blocking agents. However, a review of current literature reveals that the adverse effect profile depends on the route, dose, and formulation of the octreotide used along with the clinical indication. These adverse effects may not be clinically significant with the doses used for treatment of sulfonylurea-induced hypoglycemia and the benefits of the drug may outweigh the risks.
In these cases, octreotide was safely and effectively used in the treatment of sulfonylurea-induced hypoglycemia in patients with congestive heart failure by adhering to dosing guidelines and close monitoring.
报告 2 例重症充血性心力衰竭患者使用皮下奥曲肽治疗磺酰脲类药物诱导的低血糖症的安全性。
2 例充血性心力衰竭伴收缩功能障碍患者因肾功能衰竭导致药物半衰期延长和口服摄入减少，出现磺酰脲类药物继发严重低血糖（血糖水平：患者 1，31mg/dL；患者 2，36mg/dL）。补充葡萄糖不能纠正低血糖，患者 1 接受了 2 次 50μg 奥曲肽皮下注射，间隔 12 小时，低血糖得到纠正（奥曲肽给药前血糖水平：<33mg/dL，首剂后 62mg/dL，第 2 剂后 121mg/dL）。患者 2 接受了 25μg 奥曲肽初始剂量，该剂量后低血糖仍持续存在，给予 2 次 50μg 奥曲肽皮下注射，间隔 12 小时，低血糖得到纠正（奥曲肽给药前血糖水平：57mg/dL，首剂后 80mg/dL，第 2 剂后 85mg/dL，第 3 剂后 146mg/dL）。奥曲肽治疗低血糖的疗效使患者无需长时间静脉输注葡萄糖。在治疗过程中未观察到局部或全身不良反应，特别是心脏不良事件。
奥曲肽被认为是磺酰脲类药物诱导低血糖的解毒剂。对于可能无法耐受葡萄糖静脉输注的充血性心力衰竭患者，它可能特别有用。药物说明书警告可能发生心脏不良事件，如心动过缓、心脏传导阻滞和心力衰竭恶化。由于房室阻滞剂的同时使用，心力衰竭患者理论上可能有更高的这些不良反应风险。然而，对当前文献的回顾表明，不良反应谱取决于奥曲肽的使用途径、剂量和制剂以及临床适应证。在治疗磺酰脲类药物诱导的低血糖症时，使用这些剂量可能不会产生临床意义的不良反应，而且药物的益处可能超过风险。
在这些情况下，根据剂量指南和密切监测，奥曲肽安全有效地用于治疗充血性心力衰竭患者的磺酰脲类药物诱导的低血糖症。
