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Trimethoprim–sulfamethoxazole-induced refractory hypoglycaemia successfully treated with octreotide
  1. Jordan Kit Mah1,
  2. Daniel Negreanu1,
  3. Suhaib Radi2,3 and
  4. Stavroula Christopoulos4
  1. 1Department of Internal Medicine, McGill University, Montreal, Quebec, Canada
  2. 2Endocrine Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada
  3. 3Division of Endocrinology, Department of Medicine, King Saud bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, Saudi Arabia
  4. 4Division of Endocrinology, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Suhaib Radi; suhaibradi{at}


Trimethoprim–sulfamethoxazole (TMP–SMX) is a commonly prescribed antimicrobial agent for a wide variety of infections. It is generally well tolerated in a majority of patients; however, serious adverse effects have been described with its usage. Hypoglycaemia is an exceedingly rare but potentially life-threatening side effect of this antimicrobial agent due to its sulfonylurea-like effect. We describe a case of symptomatic, refractory hypoglycaemia secondary to TMP–SMX in a patient being treated for Stenotrophomonas maltophilia bacteraemia, which required treatment with 10 hours of intravenous dextrose (including several 50% dextrose boluses), as well as intramuscular glucagon and octreotide. We reviewed previous case reports described in the literature of TMP–SMX-induced hypoglycaemia, in which renal insufficiency was noted to be a common predisposing risk factor in an overwhelming majority of cases. In refractory cases of TMP–SMX-induced hypoglycaemia, intravenous octeotride may be considered for treatment.

  • drugs: endocrine system
  • general practice / family medicine
  • unwanted effects / adverse reactions
  • infections
  • endocrinology

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  • Contributors JKM and DN wrote the original draft of the manuscript. SR and SC contributed to the writing-review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.