Acute Kidney Injury from Excessive Potentiation of Calcium-channel Blocker via Synergistic CYP3A4 Inhibition by Clarithromycin Plus Voriconazole
نویسندگان
چکیده
CYP3A4-inhibitors can potentiate the hypotensive effect of calcium-channel blockers. However, insufficient attention to such drug interactions may result in serious adverse reactions. A 71-year-old hypertensive man prescribed nifedipine was hospitalized for infectious endophthalmitis. Antimicrobial therapy with voriconazole lowered the blood pressure, and then clarithromycin further lowered it through the excessively elevated nifedipine concentration, leading to ischemic acute kidney injury. After the discontinuation of clarithromycin and voriconazole, the blood pressure and renal function were recovered. The combination of CYP3A4-inhibitors such as clarithromycin plus voriconazole can synergistically potentiate calcium-channel blockers. Co-prescription of multiple CYP3A4-inhibitors with calcium-channel blockers increases the risk of hypotension and acute kidney injury.
منابع مشابه
Hypotension induced by the concomitant use of a calcium-channel blocker and clarithromycin
In the elderly, calcium-channel blockers are the first-line treatment for hypertension, and macrolides are commonly prescribed antibiotics. Here we report a 78-year-old man taking nifedipine, diltiazem and carvedilol who presented with persistent hypotension and bradycardia after clarithromycin was prescribed. He was diagnosed with drug-induced hypotension and treated with fluid resuscitation a...
متن کاملRole of a voltage-sensitive calcium channel blocker on inhibition of apoptosis in sensory neurons of cultured dorsal root ganglia in adult rat
Introduction: Under pathological conditions, abnormal increase in intracellular calcium concentrations is believed to induce cell death. In the present study, a voltage-sensitive calcium channel blocker (loperamide hydrochloride) was used to investigate its role in inhibition of apoptosis in sensory neurons of cultured spinal dorsal root ganglia (DRG). Methods: L5 DRG from adult rats were di...
متن کاملRisks of Adverse Events Following Coprescription of Statins and Calcium Channel Blockers
Some statins (simvastatin, lovastatin, and atorvastatin) are metabolized by cytochrome P450s 3A4 (CYP3A4). Inhibitors of CYP3A4 including some calcium channel blockers (CCBs) might increase statin blood concentration, owing to drug-drug interactions. Risk of adverse events such as acute kidney injury might occur following the coprescription of CYP3A4-metabolized statins and CCBs that inhibit CY...
متن کاملFrom a fish tank injury to hospital haemodialysis: the serious consequences of drug interactions.
We present the case of a 68-year-old man admitted to hospital with severe acute kidney injury secondary to statin-induced rhabdomyolysis. Five weeks previously, the patient started a course of clarithromycin for infection of a finger wound with Mycobacterium marinum. His current medications included simvastatin, which he continued along with clarithromycin. The severity of the acute kidney inju...
متن کاملStatin toxicity from macrolide antibiotic coprescription: a population-based cohort study.
BACKGROUND Clarithromycin and erythromycin, but not azithromycin, inhibit cytochrome P450 isoenzyme 3A4 (CYP3A4), and inhibition increases blood concentrations of statins that are metabolized by CYP3A4. OBJECTIVE To measure the frequency of statin toxicity after coprescription of a statin with clarithromycin or erythromycin. DESIGN Population-based cohort study. SETTING Ontario, Canada, f...
متن کامل