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A case of complete atrioventricular block with extremely high blood concentration of azelnidipine

BACKGROUND: Azelnidipine, a dihydropyridine calcium channel blocker (CCB), has less adverse effects (e.g. hot flushes and reflex tachycardia) compared to other dihydropyridine CCBs. Azelnidipine has been reported to reduce heart rate as opposed to inducing tachycardia. No evidence of bradycardia or...

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Autores principales: Ide, Naohito, Mochizuki, Ayaka, Kagawa, Yoshiyuki, Ito, Masaharu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638419/
https://www.ncbi.nlm.nih.gov/pubmed/34847962
http://dx.doi.org/10.1186/s40780-021-00230-x
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author Ide, Naohito
Mochizuki, Ayaka
Kagawa, Yoshiyuki
Ito, Masaharu
author_facet Ide, Naohito
Mochizuki, Ayaka
Kagawa, Yoshiyuki
Ito, Masaharu
author_sort Ide, Naohito
collection PubMed
description BACKGROUND: Azelnidipine, a dihydropyridine calcium channel blocker (CCB), has less adverse effects (e.g. hot flushes and reflex tachycardia) compared to other dihydropyridine CCBs. Azelnidipine has been reported to reduce heart rate as opposed to inducing tachycardia. No evidence of bradycardia or complete atrioventricular block (CAVB) with azelnidipine treatment has been reported. CASE PRESENTATION: In the present study, a 92-year-old woman was diagnosed with CAVB while taking azelnidipine and simvastatin for an extended period of time, and referred to our medical center. It was thought that the CAVB may have been an adverse effect of azelnidipine treatment. Specifically, it was considered that in this patient, one of the causes might be the concomitant use of simvastatin inhibiting the metabolism of azelnidipine by cytochrome P450 enzyme 3A4. Consequently, it was suggested to the patient’s physician that the patient’s serum azelnidipine levels be measured and treatment with azelnidipine and simvastatin be discontinued. The patient’s serum concentration of azelnidipine at the time of her visit to our center was 63.4 ng/mL, higher than the normal acceptable level. There was no occurrence of CAVB for 4 weeks, to present, following discontinuation of azelnidipine and simvastatin treatment. CONCLUSIONS: Azelnidipine has a different mechanism of action that other CCBs. In very rare cases, it may cause CAVB when combined with CYP3A4 inhibitors. If a patient taking azelnidipine is diagnosed with CAVB, physicians should suspect that the condition may be an adverse effect of azelnidipine and should consider discontinuing azelnidipine. And, in the elderly, it is necessary to avoid concomitant use of CYP3A4 inhibitors.
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spelling pubmed-86384192021-12-03 A case of complete atrioventricular block with extremely high blood concentration of azelnidipine Ide, Naohito Mochizuki, Ayaka Kagawa, Yoshiyuki Ito, Masaharu J Pharm Health Care Sci Case Report BACKGROUND: Azelnidipine, a dihydropyridine calcium channel blocker (CCB), has less adverse effects (e.g. hot flushes and reflex tachycardia) compared to other dihydropyridine CCBs. Azelnidipine has been reported to reduce heart rate as opposed to inducing tachycardia. No evidence of bradycardia or complete atrioventricular block (CAVB) with azelnidipine treatment has been reported. CASE PRESENTATION: In the present study, a 92-year-old woman was diagnosed with CAVB while taking azelnidipine and simvastatin for an extended period of time, and referred to our medical center. It was thought that the CAVB may have been an adverse effect of azelnidipine treatment. Specifically, it was considered that in this patient, one of the causes might be the concomitant use of simvastatin inhibiting the metabolism of azelnidipine by cytochrome P450 enzyme 3A4. Consequently, it was suggested to the patient’s physician that the patient’s serum azelnidipine levels be measured and treatment with azelnidipine and simvastatin be discontinued. The patient’s serum concentration of azelnidipine at the time of her visit to our center was 63.4 ng/mL, higher than the normal acceptable level. There was no occurrence of CAVB for 4 weeks, to present, following discontinuation of azelnidipine and simvastatin treatment. CONCLUSIONS: Azelnidipine has a different mechanism of action that other CCBs. In very rare cases, it may cause CAVB when combined with CYP3A4 inhibitors. If a patient taking azelnidipine is diagnosed with CAVB, physicians should suspect that the condition may be an adverse effect of azelnidipine and should consider discontinuing azelnidipine. And, in the elderly, it is necessary to avoid concomitant use of CYP3A4 inhibitors. BioMed Central 2021-12-01 /pmc/articles/PMC8638419/ /pubmed/34847962 http://dx.doi.org/10.1186/s40780-021-00230-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Ide, Naohito
Mochizuki, Ayaka
Kagawa, Yoshiyuki
Ito, Masaharu
A case of complete atrioventricular block with extremely high blood concentration of azelnidipine
title A case of complete atrioventricular block with extremely high blood concentration of azelnidipine
title_full A case of complete atrioventricular block with extremely high blood concentration of azelnidipine
title_fullStr A case of complete atrioventricular block with extremely high blood concentration of azelnidipine
title_full_unstemmed A case of complete atrioventricular block with extremely high blood concentration of azelnidipine
title_short A case of complete atrioventricular block with extremely high blood concentration of azelnidipine
title_sort case of complete atrioventricular block with extremely high blood concentration of azelnidipine
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8638419/
https://www.ncbi.nlm.nih.gov/pubmed/34847962
http://dx.doi.org/10.1186/s40780-021-00230-x
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