기타학회
| The risk of hypotension following co-administration of macrolide antibiotics and calcium-channel blockers in Korean | ||
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학회명 : ASHP 47th Midyear Clinical Meeting & Exhibition
Department of Pharmacy, Asan Medical Center 388-1, Pungnab-Dong, Songpa-Gu, Seoul, Korea
Abstract Purpose. The macrolide antibiotics may potentiate the effect of calcium channel blockers(CCBs) by inhibiting cytochrome P450 3A4. We explored the risk of hypotension associated with the simultaneous use of CCBs and macrolide antibiotics.
Methods. We conducted case-crossover study involving inpatients between April 1, 2010, and March 31, 2011 in 2,700 bed tertiary care hospital in Seoul, in Korea. We estimated the risk of hypotension associated with the use of a CCBs using a pair-matched analytic approach to contrast each patient's exposure to each macrolide antibiotic (erythromycin, clarithromycin or azithromycin) in co-administered period and in period preceding 30 days. We included patients who administered both medications over 3 day and had been received CCBs over 1 month before co-administration.
Results. A total of 84 patients with a mean (±SD) age of 66.4 (±13.7) years were studied, of whom 58 (69.0%) were male. Systolic and diastolic blood pressure was reduced 12.31±1.83 mmHg, 7.34±1.15 mmHg, in co-administration period compared with in period preceding 1 month. The incidence of hypotension defined by International Classification of Diseases-9 (ICD-9) was 28.6%. Although other risk factors (age, sex, type of CCBs, co-administration duration, etc) were not statistically significant, erythromycin was most strongly associated with hypotension (odds ratio [OR] 2.44, 95% confidence interval [CI] 1.1-5.2, p=0.04).
Conclusion. Co-administration of macrolide antibiotics and CCBs was associated with a reduction of blood pressure, in particularly erythromycin. Clinicians should be aware of the potential interaction between these drugs, and need to monitor the patients carefully.
Index terms: Azithromycin; Calcium channel blocker; Clarithromycin; Drug interaction; Erythromycin; Hypotension; Macrolide antibiotics
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