Severe secondary hyperkalemia and arrhythmia from drug interactions between calcium-channel blocker and voriconazole: a case presentation.

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.

• Authors: Xinju Zhao, Chunyan Zhang, Li Zhu, Bei Wu, Yun Han, Michael Heung, Li Zuo
• Journal: BMC nephrology (BMC Nephrol) Vol. 22 Issue 1 Pg. 172 (05 10 2021) ISSN: 1471-2369 [Electronic] England
• PMID: 33971831 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Antineutrophil Cytoplasmic
• Antifungal Agents
• Antihypertensive Agents
• Calcium Channel Blockers
• Cytochrome P-450 CYP3A Inhibitors
• Voriconazole

Topics

• Acute Kidney Injury (chemically induced, therapy)
• Aged
• Antibodies, Antineutrophil Cytoplasmic
• Antifungal Agents (adverse effects)
• Antihypertensive Agents (adverse effects)
• Calcium Channel Blockers (adverse effects)
• Cytochrome P-450 CYP3A Inhibitors (adverse effects)
• Diagnosis, Differential
• Drug Interactions
• Female
• Humans
• Hyperkalemia (chemically induced, drug therapy)
• Renal Replacement Therapy
• Sinus Arrest, Cardiac (chemically induced, drug therapy)
• Vasculitis (complications, diagnosis, drug therapy)
• Voriconazole (adverse effects)