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Adalat CC and E.E.S, 400 Tablets

Determining the interaction of Adalat CC and E.E.S, 400 Tablets and the possibility of their joint administration.

Check result:
Adalat CC <> E.E.S, 400 Tablets
Relevance: 06.04.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using NIFEdipine and erythromycin together can increase the effects of NIFEdipine and lower your blood pressure. This can cause a slow heartbeat, headaches, dizziness, or feeling like you might pass out. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or need your blood pressure checked more often if you take both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: An interaction between clarithromycin and nifedipine was suspected in a case of vasodilatory shock. The proposed mechanism is clarithromycin inhibition of nifedipine metabolism via CYP450 3A4, resulting in increased plasma levels and pharmacologic effects of nifedipine. The case report describes a 77-year-old male with poorly controlled type 2 diabetes and primary arterial hypertension who developed clinical derangement, hyperglycemia, metabolic acidosis with hyperkalemia, shock, heart block, and multiorgan failure 2 days after clarithromycin was added to his antihypertensive regimen, which consisted of twice-a-day captopril 25 mg, doxazosin 8 mg, and sustained-release nifedipine 60 mg just prior to hospital admission. Invasive monitoring revealed hyperdynamic shock with decreased systemic vascular resistance. Theoretically, this interaction may also occur with other macrolide antibiotics that inhibit CYP450 3A4 such as erythromycin. In fact, erythromycin was administered intravenously during the patient's hospitalization and may have contributed to the good blood pressure control achieved prior to discharge during which he received half the pre-admission dosage of nifedipine with furosemide as his only antihypertensive medications.

MANAGEMENT: Caution is advised if nifedipine is prescribed with macrolides that inhibit CYP450 3A4. Pharmacologic response to nifedipine should be monitored more closely whenever a macrolide such as clarithromycin or erythromycin is added to or withdrawn from therapy, and the nifedipine dosage adjusted as necessary. Patients should be advised to contact their physician if they experience excessive adverse effects of nifedipine such as hypotension (as indicated by dizziness, lightheadedness, or fainting), irregular heart beats, peripheral edema, and dyspnea.

References
  • Geronimo-Pardo M, Cuartero-Del-Pozo AB, Jimenez-Vizuete JM, Cortinas-Saez M, Peyro-Garcia R "Clarithromycin-nifedipine interaction as possible cause of vasodilatory shock." Ann Pharmacother 39 (2005): 538-42
Adalat CC

Generic Name: nifedipine

Brand name: Adalat CC, Afeditab CR, Nifediac CC, Nifedical XL, Procardia, Procardia XL, Adalat

Synonyms: n.a.

E.E.S, 400 Tablets

Generic Name: erythromycin

Brand name: EES. Granules, EES-400 Filmtab, EryPed 200, EryPed 400, Ery-Tab, Erythrocin Lactobionate, Erythrocin Stearate Filmtab, PCE Dispertab, E. E. S, EryPed, Erythrocin, Erythromycin Filmtabs, Erythromycin Lactobionate - IV

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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