Hypotensive syncope induced by the combination of benidipine and nirmatrelvir/ritonavir
10.3760/cma.j.cn114015-20230814-00597
- VernacularTitle:贝尼地平与奈玛特韦/利托那韦联用致低血压晕厥
- Author:
Li YAN
1
;
Jianying LIU
;
Wen PAN
Author Information
1. 上海市眼科医院药剂科/上海市眼病防治中心，上海 200041
- Publication Type:Journal Article
- Keywords:
Antiviral agents;
Syncope;
Hypotension;
Drug interactions;
Ritonavir;
Nirmatrelvir;
Benidipine;
Cytochrome P450;
COVID-19
- From:
Adverse Drug Reactions Journal
2024;26(6):376-379
- CountryChina
- Language:Chinese
-
Abstract:
A 67-year-old male patient received long-term use of benidipine (8 mg once daily orally) and allisartan isoproxil (240 mg once daily orally) due to hypertension. Her blood pressure was controlled at around 150/80 mmHg. Due to the novel coronavirus infection, he experienced syncope, decreased blood pressure and unclear consciousness after self-administration of 3 doses of nirmatrelvir 300 mg/ritonavir 100 mg (Paxlovid). Continuous intravenous infusion of dopamine 200 mg/d was given. Two hours later, his blood pressure was 103/46 mmHg, heart rate was 50 beats/min, and blood oxygen saturation was 0.92; electrocardiogram showed sinus bradycardia (45 beats/min), and complete right bundle branch block. Antihypertensive medications were discontinued, his blood pressure gradually increased to 116/82, and dopamine was discontinued. After 5 days of antihypertention drug withdrawal, the patient′s blood pressure was 169/93 mmHg and antihypertensive drug treatment was gradually resumed, 8 days later, the patient′s blood pressure was 130/78 mmHg. The possibility of neurogenic, cardiogenic, and reflexive syncope were excluded through physical examination, long-term electroencephalography, virus antibody testing, head magnetic resonance imaging, electrocardiogram, myocardial enzyme testing, and other related tests. The occurrence and recovery time of hypotension syncope in the patient were consistent with the inhibition and recovery time of cytochrome P450 (CYP) 3A4 by ritonavir. Benidipine was mainly metabolized through CYP3A4 in the liver. Therefore, it was considered that the hypotension syncope in the patient was related to the enhanced antihypertensive effect of benidipine by ritonavir.
