Does Levaquin Drop Your Blood Pressure and Cause Severe Hypoglycemia?

I learned last night that Levaquin can cause a patient's blood pressure to drop rather significantly at times. At least that's what the ER nurses told me.  I'd never heard this before, but then again, I'm rarely present when a nurse hangs an antibiotic.    They say the effect usually kicks in after about 15 minutes and can drop the systolic a good 30 mmHg, which can wreak havoc on patients that are already septic.  The nurses were all in agreement. They've all seen it.  One RN swears that the blood pressure lowering effect of intravenous Levaquin happens in up to 90% of her patients.   So I looked it up by reference.  There it was:  A sharp drop in blood pressure.

Well, chalk up this hospitalist to not knowing that Levaquin could frequently cause such a dramatic and rapid drop in blood pressure.  It's just another thing to consider for the differential diagnosis of hypotensive patients.  In addition to what seems to  be a more toxic Clostridium difficile strain and severity of pseuodmembranous colitis with Levaquin, and prolonged QTc interval, I have one more reason not to give this medication as a matter of default for many infectious etiologies.

UPDATE 2013!  A have also learned from the nursing team that Levaquin in combination with glyburide or other sulfonylurea drugs can cause severe life threatening hypoglycemia.  This effect is more likely seen in the setting insulin use and with impaired renal clearance, which by itself can increase the risk of hypoglycemia with sulfonylurea drugs.  I looked it up.  Ten years of practice and I've never had this alert pointed out by other trained professionals, such as a pharmacist.  They have a powerful data base for drug-drug interactions.  There's lots of data indicating hypoglycemia as a potential severe side effect in diabetic patients receiving concurrent therapy with quinolone thereapy and sulfonylurea drugs.  The exact mechanism is not known.

Thank you nursing for a job well done for pointing out this clinical information.  One more thing to consider when trying to decide your level of evaluation and management service. It also gives the physician an opportunity to consider this interaction as a high risk drug management parameter when determining the appropriate evaluation and management code.   

Facebook education:

--> I just learned Levaquin use with glyburide can cause severe life threatening hypoglycemia. I never knew that. 10 years of hospitalist medicine and it's never too late to learn something new. Levaquin can also cause hypotension, in case you were wondering...


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