Case Report: Nifedipine-Rifampicin Interaction Attenuates the Effect on Blood Pressure in a Patient with Essential Hypertension

Tada, Yutaka; Tsuda, Yasuo; Otsuka, Takeshi; Nagasawa, Kohei; Kimura, Hideto; Kusaba, Tomohiro; Sakata, Toshile

doi:10.1097/00000441-199201000-00006

Cited by 24 publications

(16 citation statements)

References 12 publications

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“…For example, rifampicin markedly reduces the bioavailability of nifedipine following its oral administration, through the induction of CYP3A4 (Holtbecker et al, 1996). There is some evidence that this can lead to the therapeutic failure of nifedipine (Tada et al, 1992). Induction can also increase the systemic elimination of drugs, leading to reduced accumulation and lower plasma concentrations.…”

Section: Clinical Consequences Of Metabolism-based Drug Interactionsmentioning

confidence: 99%

Drug interactions

Boobis

Watelet

Whomsley³

et al. 2009

Drug Metabolism Reviews

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Drugs for allergy are often taken in combination with other drugs, either to treat allergy or other conditions. In common with many pharmaceuticals, most such drugs are subject to metabolism by P450 enzymes and to transmembrane transport. This gives rise to considerable potential for drug-drug interactions, to which must be added consideration of drug-diet interactions. The potential for metabolism-based drug interactions is increasingly being taken into account during drug development, using a variety of in silico and in vitro approaches. Prediction of transporter-based interactions is not as advanced. The clinical importance of a drug interaction will depend upon a number of factors, and it is important to address concerns quantitatively, taking into account the therapeutic index of the compound.

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Section: Clinical Consequences Of Metabolism-based Drug Interactionsmentioning

confidence: 99%

Drug interactions

Boobis

Watelet

Whomsley³

et al. 2009

Drug Metabolism Reviews

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“…[196,197] In a report by Barbarash,[200] the serum concentration of verapamil in a patient receiving concomitant treatment with verapamil and rifampicin appeared inappropriately low for his dosage regimen. It is known to induce hepatic drug metabolism via activation of cytochrome P450.…”

Section: Rifampicinmentioning

confidence: 99%

Calcium Antagonists

Rosenthal

Ezra²

1995

Drug Safety

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The interaction of calcium antagonists, including the dihydropyridine calcium antagonists (e.g. nifedipine), verapamil and diltiazem, with drugs from other classes has major clinical ramifications as the use of drug combinations increases in frequency. Combinations are used in the treatment of disorders ranging from hypertension to cardiac rhythm disturbances, angina pectoris and peripheral vasospastic disease. In this era of organ transplantation, drugs like cyclosporin are coming into potential conflict with an ever-growing list of drugs. Drug combinations used as part of long term therapies are also making their appearance in toxic drug reactions, including antituberculous and anticonvulsant agents. Bronchodilators and H2-blockers also fall into this category of potential culprits of combined drug toxicity, and the interactions of calcium antagonists with beta-blockers and antiarrhythmic agents are also becoming a matter of concern.

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“…These interactions have been particularly problematic with the concurrent use of rifampin and antihypertensive drugs. Many case reports documented that blood pressure in these patients was more difficult to control, [4][5][6][7][8][9][10][11][12][13][14][15][16] and most of the drugs used were calcium channel blockers (CCBs). However, rifampin can also affect the function of drug transporters because it is an inhibitor of organic anion transporter polypeptides (OATPs) and P-glycoprotein (P-gp), as well as an inducer of P-gp.…”

mentioning

confidence: 99%

“…Previous case reports and human pharmacokinetic and pharmacodynamic studies reported the interactions between rifampin and antihypertensive drugs. [4][5][6][7][8][9][10][11][12][13][14][15][16][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] However, to our knowledge, no systematic summary or predictions of these interactions have been published. Thus we used the Biopharmaceutics Drug Disposition Classification System (BDDCS) to predict the direction and relative extent of both transporterbased DDIs and metabolic interactions.…”

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confidence: 99%

Predicting Interactions between Rifampin and Antihypertensive Drugs Using the Biopharmaceutics Drug Disposition Classification System

et al. 2020

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Study Objective Lack of blood pressure control is often seen in hypertensive patients concomitantly taking antituberculosis medications due to the complex drug‐drug interactions between rifampin and antihypertensive drugs. Therefore, it is of clinical importance to understand the underlying mechanisms of these interactions to help formulate recommendations on the use of antihypertensive drugs in patients taking these medications concomitantly. Our objective was to assess the reliability of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to predict potential interactions between rifampin and antihypertensive drugs and thus provide recommendations on the choice of antihypertensive drugs in patients receiving rifampin. Design Evidence‐based in vitro and in vivo predictions of drug‐drug interactions. Measurements and Main Results We systematically evaluated interactions between rifampin and antihypertensive drugs using the theory of the BDDCS, taking into consideration the role of drug transporters and metabolic enzymes involved in these interactions. We provide recommendations on the selection of antihypertensive drugs for patients with tuberculosis. Antihypertensive drugs approved by the U.S. Food and Drug Administration and the China National Medical Products Administration were included in this study. The drugs were classified into four categories under the BDDCS classification. Detailed information on cytochrome P450 (CYP) enzymes and drug transporters for each antihypertensive drug was searched in PubMed and other electronic databases. This information was combined with the effects of rifampin on CYP enzymes and drug transporters, and the direction and relative extent of the potential interactions between rifampin and antihypertensive drugs were predicted. Recommendations were then made using the theory of BDDCS. A thorough systematic literature review was performed, and data from all published human studies and case reports were summarized for the validation of our predictions. Interventional and observational studies published in PubMed and two Chinese databases (CNKI and WanFang) through December 16, 2019, were included, and data were extracted for validation of the predictions. Using the BDDCS theory, class 3 active drugs were predicted to exhibit minimal interactions with rifampin. On reviewing case reports and pre‐post studies, the predictions we made were found to be reliable. When antituberculosis medications that include rifampin are started in patients with hypertension, it is recommended that the use of calcium channel blockers and classes 1 and 2 β‐blockers be avoided. Angiotensin‐converting enzyme inhibitors, olmesartan, class 3 β‐blockers, spironolactone, and hydrochlorothiazide would be preferable because clinically relevant interactions would not be expected. Conclusion Application of the BDDCS to predict interactions between rifampin and antihypertensive drugs for patients with both tuberculosis and hypertension was found to be reliable. It should be noted, however, that bas...

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Case Report: Nifedipine-Rifampicin Interaction Attenuates the Effect on Blood Pressure in a Patient with Essential Hypertension

Cited by 24 publications

References 12 publications

Drug interactions

Drug interactions

Calcium Antagonists

Predicting Interactions between Rifampin and Antihypertensive Drugs Using the Biopharmaceutics Drug Disposition Classification System

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