Mishima Eikan, Maruyama Kazuichi, Nakazawa Toru, Abe Takaaki, Ito Sadayoshi
Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Japan.
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Japan.
Intern Med. 2017;56(13):1687-1690. doi: 10.2169/internalmedicine.56.8313. Epub 2017 Jul 1.
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.
CYP3A4抑制剂可增强钙通道阻滞剂的降压作用。然而，对这类药物相互作用的关注不足可能会导致严重的不良反应。一名71岁的高血压男性患者，因感染性眼内炎住院，正在服用硝苯地平。伏立康唑抗菌治疗使血压降低，随后克拉霉素通过过度升高的硝苯地平浓度进一步降低血压，导致缺血性急性肾损伤。停用克拉霉素和伏立康唑后，血压和肾功能恢复。克拉霉素加伏立康唑等CYP3A4抑制剂联合使用可协同增强钙通道阻滞剂的作用。多种CYP3A4抑制剂与钙通道阻滞剂合用会增加低血压和急性肾损伤的风险。
