Severe Secondary Hyperkalemia and Arrhythmia from Drug Interactions Between Calcium-channel Blocker and Voriconazole: a Case Presentation

Overview

Journal BMC Nephrol

Publisher Biomed Central

Specialty Nephrology

Date 2021 May 11

PMID 33971831

Authors

Xinju Zhao

Chunyan Zhang

Li Zhu

Bei Wu

Yun Han

Michael Heung

Li Zuo

Affiliations

Soon will be listed here.

Abstract

Background: Patients with kidney disease may have concurrent hypertension and infection. Dihydropyridine calcium-channel blockers (CCB) are the most popular class of antihypertensive drugs used in clinical settings and can be metabolized by cytochrome P450 isoenzyme 3A4 (CYP3A4). Voriconazole is a commonly used antifungal treatment and a CYP3A4-inhibitor. Insufficient attention to drug interactions from the concomitant use of CCB and voriconazole may result in serious adverse reactions.

Case Presentation: Here, we report a patient with acute kidney injury on stable anti-neutrophil cytoplasm antibody associated vasculitis who developed hyperkalemia resulting in sinus arrest with junctional escape rhythm attributed to drug interactions of CCB with voriconazole. This is a very rarely reported case and may be an under-recognized complication. After continuous renal replacement therapy and changing the anti-hypertensive drugs, symptoms, and laboratory abnormalities of the patient fully recovered.

Conclusions: This case warns us of severe consequences of drug interactions. Co-prescription of CYP3A4-inhibitors with calcium-channel blockers increases the risk of hypotension and acute kidney injury, which may further induce hyperkalemia and arrhythmia.

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