Hypotension and syncope with acute kidney injury caused by the combination of simnotrelvir/ritonavir and benidipine
10.3760/cma.j.cn114015-20241219-00214
- VernacularTitle:先诺特韦/利托那韦与贝尼地平联用致低血压晕厥伴急性肾损伤
- Author:
Zhilian XU
1
Author Information
1. 浙江中医药大学附属杭州市中医院药学部，杭州 310007
- Publication Type:Journal Article
- Keywords:
Antiviral agents;
Syncope;
Hypotension;
Acute kidney injury;
Drug interactions;
Ritonavir;
Simnotrelvir;
Benidipine;
Novel coronavirus infection
- From:
Adverse Drug Reactions Journal
2025;27(11):696-698
- CountryChina
- Language:Chinese
-
Abstract:
A 69-year-old male patient with hypertension was treated with long-term oral administration of benidipine (8 mg, once daily) and losartan (100 mg, once daily). Due to the novel coronavirus infection, he took simnotrelvir/ritonavir (1.5 g of simnotrelvir, 0.1 g of ritonavir) by himself. After 10 hours, he experienced syncope and unconsciousness. His blood pressure was 70/40 mmHg, heart rate was 40 times/min, and consciousness recovered about 15 minutes later. Laboratory tests showed B-type natriuretic peptide 233 ng/L and blood creatinine 188 μmol/L. Electrocardiogram showed atrial fibrillation. Color Doppler ultrasound of the heart showed enlargement of both atria. Head CT showed suspicious low-density shadows in the brainstem and left frontal lobe. Immediate symptomatic treatments including fluid replacement, blood pressure increase with norepinephrine and dopamine, and anticoagulation with enoxaparin sodium were given. Antihypertensive drugs were stopped. After 1 day of symptomatic treatments, the patient′s blood pressure was 130-150/60-80 mmHg, norepinephrine and dopamine were discontinued. Three days after antihypertensive medication withdrawal, the patient′s blood pressure was 168/80 mmHg, and antihypertensive treatments were resumed (levoamlodipine 2.5 mg twice daily orally, sacubitril and valsartan 100 mg once daily orally). Eleven days later, the patient′s blood pressure was 114-135/74-78 mmHg, and blood creatinine was 96 μmol/L. It was considered that the hypotension and syncope were caused by the combination of simnotrelvir/ritonavir and benidipine, and the acute kidney injury was a prerenal injury caused by hypotension.
