Antihypertensives/antituberculars interaction
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Resistant hypertension: case report A 67-year-old man experienced resistant hypertension following concomitant administration of amlodipine, enalapril, felodipine, methyldopa, metoprolol, prazosin, spironolactone and rifampicin/isoniazid/pyrazinamide/ethambutol [routes not stated]. The man with chronic essential hypertension, had been receiving treatment with amlodipine 10mg daily. In April 2019, he was diagnosed with smear positive pulmonary tuberculosis. Subsequently, he started receiving treatment with 3 tablet of rifampicin/ isoniazid/pyrazinamide/ethambutol [Akurit-4] daily along with pyridoxine. His blood pressure control deteriorated one week after the initiation of antitubercular medications. Therefore, he started receiving antihypertensive treatment with enalapril 20mg twice daily, felodipine 10mg twice daily, metoprolol 100mg twice daily, prazosin 5mg four times daily, methyldopa 1g thrice a day and a diuretic spironolactone 50mg twice a day in addition to previous antihypertensives. During his 6 months period of tuberculosis treatment, he exhibited poor control of hypertension. However, he did not experience any organ damage or cushingoid or acromegalic features. Polycystic kidney disease and renal artery stenosis were ruled out by ultrasound of the kidneys, ureters, and bladder and CT angiography of renal arteries. A normal ejection fraction was found by echocardiography and no evidence of coarctation of aorta was observed. His thyroid function test also found in the normal range. The man’s blood pressure readings significantly improved after the completion of antitubercular therapy in October 2019. After a month, his antihypertensive drugs were reduced. He continued treatment with only amlodipine and perindopril. In January 2020, during the last medical review, his blood pressure was recorder from 120-140/70-90mm.Hg. Based on these findings, clinical presentation and after excluding the other aetiologies, it was concluded that the interaction of rifampicin/isoniazid/pyrazinamide/ ethambutol with amlodipine, enalapril, felodipine, methyldopa, metoprolol, prazosin and spironolactone resulted in resistant hypertension. Lee SL, et al. Resistant hypertension during antituberculosis treatment: How is rifampicin implicated?. Medical Journal of Malaysia 75: 591-593, No. 5, Sep 2020. Available 803515371 from: URL: http://www.e-mjm.org/2020/v75n5/pulmonary-tuberculosis.pdf
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Reactions 14 Nov 2020 No. 1830
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