ArticleCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2011
The risk of hypotension following co-prescription of macrolide antibiotics and calcium-channel blockers.
Article in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.
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42 citing papers in PubMed, 1 synthesis or guideline pooled it, 78 citations in OpenAlex.
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- Association of Direct Oral Anticoagulant-Proton Pump Inhibitor Co-Therapy with Adverse Outcomes: A Population-Based Cohort Study.The Annals of pharmacotherapy · 2026Article
- Cardiovascular effectiveness and safety of SGLT2 inhibitors vs DPP4 inhibitors by dementia status: a cohort study of older adults with diabetes.Diabetologia · 2026Article
- Adverse events with co-prescription of angiotensin receptor blockers and clarithromycin compared to azithromycin: A population-based retrospective cohort study.Pharmacotherapy · 2025Article
- Prevalence and correlates of oral antibiotic use in Canada.Canada communicable disease report = Releve des maladies transmissibles au Canada · 2024Article
- Repeated occurrence of severe hypotension associated with azithromycin infusion in a patient with fulminant myocarditis: a case report.European heart journal. Case reports · 2024Article
- Adverse events with quetiapine and clarithromycin coprescription: A population-based retrospective cohort study.Health science reports · 2023Article
- Hospital Admission Due to Hypotension in Australia and in England and Wales.Healthcare (Basel, Switzerland) · 2023Article
- Clinical Relevance of Drug-Drug Interactions With Antibiotics as Listed in a National Medication Formulary: Results From Two Large Population-Based Case-Control Studies in Patients Aged 65-100 Years Using Linked English Primary Care and Hospital Data.Clinical pharmacology and therapeutics · 2023Article
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- Gut Microbiome and Neuroinflammation in Hypertension.Circulation research · 2022Review
- Calcium Channel Blocker Toxicity: A Practical Approach.Journal of multidisciplinary healthcare · 2022Review
- Severe secondary hyperkalemia and arrhythmia from drug interactions between calcium-channel blocker and voriconazole: a case presentation.BMC nephrology · 2021Article
- Drug-Drug Interaction Surveillance Study: Comparing Self-Controlled Designs in Five Empirical Examples in Real-World Data.Clinical pharmacology and therapeutics · 2021Article
- Article
- Comparison of Self-controlled Designs for Evaluating Outcomes of Drug-Drug Interactions: Simulation Study.Epidemiology (Cambridge, Mass.) · 2019Article
- Hypotensive episodes associated with azithromycin infusion: a potentially fatal adverse drug reaction.Respirology case reports · 2019Article
- Analysis of Drug-Drug Interactions in Swiss Claims Data Using Tizanidine and Ciprofloxacin as a Prototypical Contraindicated Combination.The Annals of pharmacotherapy · 2018Article
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5 authors at 1 institution in 1 country.
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Abstract
backgroundThe macrolide antibiotics clarithromycin and erythromycin may potentiate calcium-channel blockers by inhibiting cytochrome P450 isoenzyme 3A4. However, this potential drug interaction is widely underappreciated and its clinical consequences have not been well characterized. We explored the risk of hypotension or shock requiring hospital admission following the simultaneous use of calcium-channel blockers and macrolide antibiotics.
methodsWe conducted a population-based, nested, case-crossover study involving people aged 66 years and older who had been prescribed a calcium-channel blocker between Apr. 1, 1994, and Mar. 31, 2009. Of these patients, we included those who had been admitted to hospital for the treatment of hypotension or shock. For each antibiotic, we estimated the risk of hypotension or shock associated with the use of a calcium blocker using a pair-matched analytic approach to contrast each patient's exposure to each macrolide antibiotic (erythromycin, clarithromycin or azithromycin) in a seven-day risk interval immediately before admission to hospital and in a seven-day control interval one month earlier.
resultsOf the 7100 patients admitted to hospital because of hypotension while receiving a calcium-channel blocker, 176 had been prescribed a macrolide antibiotic during either the risk or control intervals. Erythromycin (the strongest inhibitor of cytochrome P450 3A4) was most strongly associated with hypotension (odds ratio [OR] 5.8, 95% confidence interval [CI] 2.3-15.0), followed by clarithromycin (OR 3.7, 95% CI 2.3-6.1). Azithromycin, which does not inhibit cytochrome P450 3A4, was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). We found similar results in a stratified analysis of patients who received only dihydropyridine calcium-channel blockers.
interpretationIn older patients receiving a calcium-channel blocker, use of erythromycin or clarithromycin was associated with an increased risk of hypotension or shock requiring admission to hospital. Preferential use of azithromycin should be considered when a macrolide antibiotic is required for patients already receiving a calcium-channel blocker.
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