Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
Am J Health Syst Pharm. 2010 Oct 1;67(19):1606-10. doi: 10.2146/ajhp090657.
A case of severe bradycardia and hypotension associated with concomitant tizanidine and lisinopril therapy is reported.
An 85-year-old man with a chief complaint of profound weakness was admitted to the hospital with a blood pressure reading of 60/32 mm Hg and a heart rate of 37 beats/min. His medical history included type 2 diabetes mellitus, congestive heart failure, gastroesophageal reflux disease, chronic obstructive pulmonary disease, osteoarthritis, restless leg syndrome, benign prostatic hyperplasia, generalized anxiety disorder with depression, and severe chronic back pain for which he was receiving treatment at a pain clinic. Two days before hospital admission, he had been seen at the pain clinic and started on ti-zanidine. Additional medications included acetaminophen, chlorpromazine, citalopram, finasteride, lidocaine patch, lisinopril, metformin, pramipexole, omeprazole, simvastatin, theophylline, diclofenac topical gel, hydrocodone-acetaminophen, and ondansetron. After taking three doses of the newly prescribed tizanidine, he developed severe hypotension and bradycardia. Notable laboratory test values included a serum creatinine concentration of 1.90 mg/dL, a blood urea nitrogen concentration of 21 mg/dL, a serum potassium concentration of 5.5 meq/L, and a serum sodium concentration of 128 meq/L. Upon admission, tizanidine, lisinopril, theophylline, omeprazole, and simvastatin were withheld, and i.v. fluids were administered. The patient's vital signs began to gradually improve. Within 24 hours, the patient's blood pressure and heart rate had improved, as had the previously abnormal laboratory test values. Tizanidine was discontinued, and all of his other preadmission medications were restarted at discharge.
The addition of tizanidine in a patient receiving long-term treatment with lisinopril was associated with severe hypotension and bradycardia.
报告一例同时使用替扎尼定和赖诺普利治疗引起严重心动过缓和低血压的病例。
一名 85 岁男性，主要诉全身乏力，血压 60/32mmHg，心率 37 次/分，入院。其既往病史包括 2 型糖尿病、充血性心力衰竭、胃食管反流病、慢性阻塞性肺疾病、骨关节炎、不安腿综合征、良性前列腺增生、伴有抑郁的广泛性焦虑症和严重慢性背痛，在疼痛诊所接受治疗。在入院前两天，他在疼痛诊所就诊并开始使用替扎尼定。其他药物包括对乙酰氨基酚、氯丙嗪、西酞普兰、非那雄胺、利多卡因贴剂、赖诺普利、二甲双胍、普拉克索、奥美拉唑、辛伐他汀、茶碱、双氯芬酸钠凝胶、氢可酮-对乙酰氨基酚和昂丹司琼。服用三剂新处方的替扎尼定后，他出现严重的低血压和心动过缓。值得注意的实验室检查值包括血清肌酐浓度 1.90mg/dL、血尿素氮浓度 21mg/dL、血清钾浓度 5.5meq/L 和血清钠浓度 128meq/L。入院后，停用替扎尼定、赖诺普利、茶碱、奥美拉唑和辛伐他汀，并给予静脉补液。患者生命体征开始逐渐改善。在 24 小时内，患者的血压和心率有所改善，之前异常的实验室检查值也有所改善。停用替扎尼定，所有其他入院前药物在出院时恢复使用。
在长期接受赖诺普利治疗的患者中添加替扎尼定会导致严重的低血压和心动过缓。
