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

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Abstract

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.

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Acknowledgments

This study was not directly funded by any funding source. Swapnil Hiremath, Brendan B. McCormick and Marcel Ruzicka receive research salary support from the Department of Medicine, University of Ottawa. Swapnil Hiremath, Brendan B. McCormick, Shankar Prasad Nagaraju and Marcel Ruzicka do not have any conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. The Renal Hypertension Unit, Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada

    Swapnil Hiremath, Marcel Ruzicka, Shankar Prasad Nagaraju & Brendan B. McCormick

  2. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Marcel Ruzicka

  3. The Clinical Epidemiology Program, Ottawa Hospital Research Institute, 5-14, The Ottawa Hospital-Riverside Campus, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada

    Swapnil Hiremath

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  1. Swapnil Hiremath
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  2. Marcel Ruzicka
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  3. Shankar Prasad Nagaraju
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  4. Brendan B. McCormick
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Correspondence to Swapnil Hiremath.

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Hiremath, S., Ruzicka, M., Nagaraju, S.P. et al. Clinical Hypotension with Co-prescription of Macrolide Antibiotics and Calcium-Channel Blockers in Haemodialysis Patients: A Retrospective Chart Review. Drug Saf 36, 989–993 (2013). https://doi.org/10.1007/s40264-013-0088-9

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  • DOI: https://doi.org/10.1007/s40264-013-0088-9

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