Biphasic dysglycemia induced by pentamidine and detected by intermittently scanned continuous glucose monitoring: a case report of a possible drug-drug interaction with clopidogrel and literature review
Abstract
BACKGROUND: Pentamidine is an alternative treatment for Pneumocystis pneumonia (PCP) in patients who are intolerant to sulfamethoxazole-trimethoprim; however, its use is limited by serious adverse effects, including glycemic fluctuations. Herein, we report a case in which intermittently scanned continuous glucose monitoring (isCGM) was used to monitor real-time glycemic fluctuations during pentamidine therapy, enabling successful completion of treatment. To contextualize this case, we also conducted a targeted literature review of pentamidine-induced glucose dysregulation. CASE PRESENTATION: An 86-year-old Japanese man undergoing immunosuppressive therapy for rheumatoid arthritis was diagnosed with PCP and initially treated with sulfamethoxazole-trimethoprim. Because of suspected adverse effects of sulfamethoxazole-trimethoprim, the patient was switched to intravenous pentamidine as second-line therapy. Given the risks associated with advanced age, abnormal kidney function, and concomitant use of clopidogrel, an organic cation transporter 1 (OCT1) inhibitor that may affect pentamidine disposition, glycemic monitoring was initiated using isCGM. The patient experienced nocturnal hypoglycemia soon after initiating pentamidine treatment, which persisted after pentamidine discontinuation. He subsequently developed marked hyperglycemia associated with impaired endogenous insulin secretion, necessitating temporary regular insulin administration and sitagliptin combination therapy.…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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