Reactions 1226 - 1 Nov 2008

SClomipramine

Diabetes mellitus in an elderly patient: case reportAn 83-year-old woman developed diabetes mellitus during

treatment with clomipramine for depression.The woman, whose medical history included hypertension

and atrial fibrillation, started receiving clomipramine25 mg/day and, 5 months later, she was hospitalised withpolyuria, dehydration and obtunded sensorium [time toreaction onset not clearly stated]. Physical examinationrevealed dehydration. On neurological examination, she hadobtunded consciousness. Laboratory investigations revealedhyperglycaemia (25.5 mmol/L), acidosis, ketonaemia and thefollowing levels: haemoglobin A1c 0.12, sodium 158 mmol/L,and creatinine 137.25 µmol/L. On urinalysis, she hadketonuria and glycosuria.

Clomipramine was withdrawn, and metaboliccompensation with IV insulin and fluids was initiated. Thewoman’s blood glucose levels normalised rapidly and, after10 days, she was discharged without insulin treatment, butwith a diabetic diet and psychological treatment. She remainedmetabolically stable.

Three months later, clomipramine was reinitiated and,1 week later, she had an increase in fasting glucose to13.88 mmol/L. She also had glycosuria and ketonuria. The drugwas withdrawn and, within 2 days, her glycaemia normalised.At last follow-up, she had remained euglycaemic withouttherapy for the past 6 months.

Author comment: "We considered our patient’shyperglycemia to be induced by clomipramine because of thetemporal relationship, the recurrence of glucose elevationwith reintroduction of the drug, and the normalization of theglucose after discontinuation of therapy with the drug."Mumoli N, et al. Clomipramine-induced diabetes. Annals of Internal Medicine149: 595-596, No. 8, 21 Oct 2008 - Italy 801124406

1

Reactions 1 Nov 2008 No. 12260114-9954/10/1226-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved