Hypoglycemic Syncope Induced by a Combination of Cibenzoline and Angiotensin Converting Enzyme Inhibitor.

Abstract

SUMMARYA 65-year-old Japanese woman with dilated cardiomyopathy, hypothyroidism and refractory sustained ventricular tachycardia experienced a near-death hypoglycemic syncope. The attack seemed to be induced by a high level of serum insulin, probably due to cibenzoline and by concomitant use of an angiotensin converting enzyme inhibitor (ACEI). Additionally, decreased food intake because of a severe toothache may have contributed to the deterioration of her condition. This case warns cardiologists that a combined cibenzoline and ACEI therapy can provoke serious adverse effects such as hypoglycemic syncope in the elderly. Therefore, the possibility of a hypoglycemic attack associated with these drugs should be explained to patients who are in poor condition. (Jpn Heart J 2001; 42: 255-259) Key words: Cibenzoline, Angiotensin converting enzyme inhibitor, Hypoglycemia, Syncope CIBENZOLINE, a class Ia drug, has been used for the treatment of both atrial and ventricular tachyarrhythmia. Angiotensin converting enzyme inhibitors (ACEIs) are used for the treatment of congestive heart failure and hypertension since they are effective and have few adverse effects. However, several reports have described hypoglycemia induced by cibenzoline [1][2][3] and ACEIs, respectively. 4,5) We had a patient with near-death hypoglycemic syncope induced by the concomitant use of cibenzoline and an ACEI.

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“…In addition, we have reported that the class Ia antiarrhythmic drug, cibenzoline, can directly improve the left ventricular pressure gradient and diastolic function in patients with HCM. 15 However, cibenzoline, which is reported to cause hypoglycemia via insulin oversecretion, 16 may be contraindicated in patients with GSD-IIIa. Treadmill exercise testing and measurements of maximal oxygen consumption have proved helpful in determining which patients may benefit from pharmacologic therapy.…”