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Megesterol acetate as an overlooked cause of hyperglycemia in end-stage renal disease: A case of polypharmacy
Background: This case report highlights an overlooked cause of hyperglycemia and risk of polypharmacy in a patient with end-stage renal disease (ESRD). Case summary: A 75-year-old non-English speaking male with type 2 diabetes mellitus, hypertension, coronary artery disease status post percutaneous coronary intervention, and ESRD secondary to immunoglobulin G kappa nephropathy on nightly peritoneal dialysis reported a loss of appetite, decrease in weight, and an increase in symptoms of depression. As a result of these symptoms, his nephrologist initiated megestrol acetate (MA), an agent commonly used in ESRD to help stimulate appetite and improve weight. After starting MA, his blood glucose (BG) significantly worsened, due to its glucocorticoid properties. Basal insulin was started to manage his hyperglycemia, but there was minimal improvement in BG. As the patient was referred to the endocrinology clinical pharmacist for diabetes management, it was id entified that his weight loss began after starting dulaglutide, which led to a weight loss of 11 kg (12.9%). The Naranjo algorithm was used, and he had a score of 6, which is a probable reaction. The patient's endocrinology and nephrology teams agreed to discontinue MA and dulaglutide as they resulted in opposing effects on appetite and BG, as well as insulin glargine. The patient's BG was tightly controlled off MA and his appetite, weight, and mood improved off dulaglutide. Practice implications: This case report reflects the potential effects of polypharmacy in ESRD, resulting in poor patient outcomes and drug interactions. It is imperative that a comprehensive medication reconciliation is completed on all patients, especially for patients on dialysis. It is also important for healthcare professionals to be cognizant of medications that may exhibit glucocorticoid properties, which can cause hyperglycemia. Including a clinical pharmacist in the care team can assist with medication reconciliation, screening for drug interactions and polypharmacy, and optimizing chronic disease management. © 2024 American Pharmacists Association®
Authors : Aurora J., Jr.; Zheng T.; Fortunati J.R.; Erenler F.
Source : Elsevier B.V.
Article Information
| Year | 2024 |
| Type | Article |
| DOI | 10.1016/j.japh.2024.102248 |
| ISSN | 15443191 |
| Volume | 64 |
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