Pesavento T E, Jones P A, Julian B A, Curtis J J
Division of Nephrology, University of Alabama at Birmingham 35294-0007, USA.
J Am Soc Nephrol. 1996 Jun;7(6):831-5. doi: 10.1681/ASN.V76831.
Calcium channel blockers (CCB) are considered the agents of choice to treat hypertension in cyclosporine (CsA)-treated renal transplant patients. Verapamil, diltiazem, and nicardipine, but not nifedipine or isradipine, can significantly increase CsA levels. The effect of a new CCB, amlodipine, has not been established. However, some hospitals are routinely switching patients to amlodipine from other CCB for reasons of cost. A case of a man with stable CsA levels who developed significantly increased CsA levels after being changed to amlodipine is presented along with a prospective trial to formally examine this issue. Eleven hypertensive, CsA-treated renal transplant patients were placed on amlodipine for an average of 6.9 wk and later withdrawn. Three measurements of CsA trough level, blood pressure, serum creatinine concentration, and BUN were obtained at baseline, during treatment with amlodipine, and after withdrawal of amlodipine. CsA levels on amlodipine increased an average of 40% above baseline (P = 0.003) and decreased to baseline (P = 0.001) after amlodipine was withdrawn, despite no significant change in CsA dose. Additionally, there was no change in serum creatinine, BUN, or mean arterial pressure values. Amlodipine can increase CsA levels
钙通道阻滞剂（CCB）被认为是治疗接受环孢素（CsA）治疗的肾移植患者高血压的首选药物。维拉帕米、地尔硫䓬和尼卡地平可显著提高CsA水平，但硝苯地平或伊拉地平则不然。新型CCB氨氯地平的作用尚未明确。然而，出于成本原因，一些医院常规将患者从其他CCB换成氨氯地平。本文报告了一例服用CsA后血药浓度稳定的男性患者，在换用氨氯地平后CsA水平显著升高的病例，并进行了一项前瞻性试验以正式研究此问题。11例接受CsA治疗的高血压肾移植患者服用氨氯地平平均6.9周后停药。在基线、服用氨氯地平期间和停用氨氯地平后分别测量3次CsA谷浓度、血压、血清肌酐浓度和血尿素氮。尽管CsA剂量无显著变化，但服用氨氯地平期间CsA水平平均比基线升高40%（P = 0.003），停用氨氯地平后降至基线水平（P = 0.001）。此外，血清肌酐、血尿素氮或平均动脉压值无变化。氨氯地平可提高CsA水平
