Clinical Hypotension with Co-prescription of Macrolide Antibiotics and Calcium-Channel Blockers in Haemodialysis Patients: A Retrospective Chart Review

• Published in: Drug safety Vol. 36; no. 10; pp. 989 - 993
• Main Authors: Hiremath, Swapnil, Ruzicka, Marcel, Nagaraju, Shankar Prasad, McCormick, Brendan B.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.10.2013; Adis International; Springer Nature B.V
• Subjects: Aged; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - pharmacokinetics; Biological and medical sciences; Blood pressure; Calcium Channel Blockers - administration & dosage; Calcium Channel Blockers - adverse effects; Calcium Channel Blockers - pharmacokinetics; Diabetes; Dihydropyridines - administration & dosage; Dihydropyridines - adverse effects; Dihydropyridines - pharmacokinetics; Drug Interactions; Drug Prescriptions - standards; Drug Safety and Pharmacovigilance; Drug therapy; Drug toxicity and drugs side effects treatment; Electronic Health Records; Female; Hemodialysis; Hospitalization; Humans; Hypotension - chemically induced; Hypotension - metabolism; Macrolides - administration & dosage; Macrolides - adverse effects; Macrolides - pharmacokinetics; Male; Medical sciences; Medicine; Medicine & Public Health; Pharmacology. Drug treatments; Pharmacology/Toxicology; Renal Dialysis; Retrospective Studies; Short Communication; Toxicity: cardiovascular system; Amlodipine; Blood Pressure Measurement; Clarithromycin; Macrolide; Azithromycin; Human; Drug combination; Hemodialysis; Toxicity; Calcium antagonist; Cardiovascular disease; Extrarenal dialysis; Antibiotic; Follow up study; Arterial hypotension; Drug interaction; Protein synthesis inhibitor; Antibacterial agent
• ISSN: 0114-5916; 1179-1942
• DOI: 10.1007/s40264-013-0088-9

Background Macrolide antibiotics inhibit the cytochrome p450 enzyme system, which metabolizes calcium-channel blockers. This may result in a clinically significant interaction, causing hypotension in patients co-prescribed these two drugs. Since these drugs are frequently used in the haemodialysis population, we studied the effect of their co-prescription on actual blood pressure. Methods A retrospective chart review of all haemodialysis patients was conducted to identify patients co-prescribed a macrolide and a dihydropyridine calcium-channel blocker. Blood pressure measurements before and during the macrolide co-prescription were abstracted and compared using a student’s t test. Results We identified 154 haemodialysis patients concurrently prescribed a macrolide antibiotic and a dihydropyridine calcium-channel blocker. There was no significant difference in episodes of intra-dialytic hypotension or actual blood pressure measurements in the period before macrolide co-prescription and the period during macrolide co-prescription. Conclusion In contrast to hospitalized patients receiving dihydropyridine calcium-channel blockers, concurrent administration of a macrolide antibiotic for infection did not result in hypotension in haemodialysis outpatients. Further research should be undertaken before a change in clinical practice against their co-prescription is considered.