Medications that increase blood glucose levels
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Medications That Increase Blood Glucose Levels: Key Drug Classes
Several commonly used medications can increase blood glucose levels, either by affecting insulin secretion, insulin sensitivity, or by other mechanisms. Understanding which drugs have this effect is important for clinicians and patients, especially those with or at risk for diabetes.
Antihypertensive Drugs: Thiazide Diuretics and Beta-Blockers
Thiazide diuretics and certain beta-blockers are well-documented to increase blood glucose levels. Thiazide diuretics, in particular, are associated with more frequent glycemic adverse events compared to other antihypertensive agents like calcium-channel blockers or renin–angiotensin system inhibitors. Non-selective beta-blockers also show a significant increase in fasting blood glucose and HbA1c in patients with diabetes, with effect sizes being largest for these drug types 13.
Lipid-Modifying Agents: Statins and Niacin
Some statins, especially at higher doses, can induce hyperglycemia, though the risk varies between different statins. Niacin (nicotinic acid), another lipid-modifying agent, is also known to alter glycemic control and increase blood glucose .
Steroids: Glucocorticoids and Dexamethasone
Glucocorticoids, such as dexamethasone, are strongly associated with increased blood glucose levels. Even a single dose of dexamethasone can cause a significant rise in blood glucose for up to 24 hours, regardless of diabetic status. In patients with diabetes, intravenous dexamethasone can transiently elevate blood glucose and increase insulin requirements, though these effects are usually temporary 178.
Psychiatric Medications: Antipsychotics and Antidepressants
Second-generation antipsychotics are linked to hyperglycemia, diabetes, and even ketoacidosis, mainly due to their effects on insulin resistance. High daily doses of certain antidepressants also increase the risk of diabetes and elevated blood glucose .
Anti-Infectives: Fluoroquinolones and HIV Medications
Fluoroquinolone antibiotics, especially at high doses, have been reported to cause severe hyperglycemia. Among HIV medications, protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhibitors, can disrupt glucose metabolism and increase blood glucose .
Other Medications
- Oral Contraceptives: Those containing high doses of estrogen have been associated with increased blood glucose .
- Chemotherapeutic Agents: Some cancer drugs carry a higher risk of hyperglycemia .
- Calcineurin Inhibitors: These drugs can decrease insulin secretion, leading to higher blood glucose .
- Growth Hormone Therapy and Somatostatin Analogues: Both can induce hyperglycemia .
- Beta-Adrenergic Stimulants and Theophylline: These can also cause increases in blood glucose and, in some cases, ketoacidosis .
- Antiepileptics: Drugs like phenytoin and valproic acid may induce hyperglycemia .
- GLP-1 Receptor Agonists: In animal studies, drugs like liraglutide have been shown to temporarily increase blood glucose in healthy rats, though this effect may not be as pronounced in humans or in diabetic states .
Drug Interactions
Some drug combinations can have a synergistic effect on blood glucose. For example, the combination of pravastatin (a statin) and paroxetine (an SSRI antidepressant) has been shown to significantly increase blood glucose, especially in patients with diabetes, even though neither drug alone has this effect .
Conclusion
A wide range of medications—including thiazide diuretics, non-selective beta-blockers, certain statins, glucocorticoids, second-generation antipsychotics, some antidepressants, fluoroquinolones, and others—can increase blood glucose levels through various mechanisms. Clinicians should be vigilant in monitoring blood glucose in patients prescribed these medications, particularly those with diabetes or at high risk for developing diabetes 123478.
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