Clinical hypotension with co-prescription of macrolide antibiotics and calcium-channel blockers in haemodialysis patients: a retrospective chart review

Drug Saf. 2013 Oct;36(10):989-93. doi: 10.1007/s40264-013-0088-9.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / pharmacokinetics
  • Calcium Channel Blockers / administration & dosage
  • Calcium Channel Blockers / adverse effects*
  • Calcium Channel Blockers / pharmacokinetics
  • Dihydropyridines / administration & dosage
  • Dihydropyridines / adverse effects*
  • Dihydropyridines / pharmacokinetics
  • Drug Interactions
  • Drug Prescriptions / standards
  • Electronic Health Records
  • Female
  • Humans
  • Hypotension / chemically induced*
  • Hypotension / metabolism
  • Macrolides / administration & dosage
  • Macrolides / adverse effects*
  • Macrolides / pharmacokinetics
  • Male
  • Renal Dialysis*
  • Retrospective Studies

Substances

  • Anti-Bacterial Agents
  • Calcium Channel Blockers
  • Dihydropyridines
  • Macrolides