Diclofenac/Lagerstroemia speciosa interaction
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First report of an interaction, leading to lactic acidosis and acute kidney injury: case report A 55-year-old man with type 2 diabetes mellitus, stage 3a chronic kidney disease and gouty arthritis developed lactic acidosis and acute kidney injury during treatment with Lagerstroemia speciosa and diclofenac. The man presented with a 2-day history of severe abdominal pain, anorexia and decreased urine output. His abdomen was tender without rebound tenderness during physical examination and serum analysis indicated urea nitrogen and creatinine levels of 69 mg/dL and 9.94 mg/dL, respectively. Arterial blood gas analysis lead to a diagnosis of lactic acid-related high-anion-gap metabolic acidosis. The man received haemodialysis treatment concomitantly with a sodium bicarbonate infusion. After 3 hours of haemodialysis, acidosis persisted, which resolved after 2 days of haemodialysis. On follow-up, he had a serum urea nitrogen level of 50 mg/dL and creatinine level of 2.2 mg/dL. He reported that he had been receiving diclofenac [dosage and route not stated] to treat joint pains and Lagerstroemia speciosa [dosage, route and indication not stated] for 1 week and 1 month before admission, respectively. Thus, it was suggested that he developed acute kidney injury due to NSAID-induced hypoperfusion which subsequently led to Lagerstroemia speciosa accumulation. He may also have had mild hypoxaemiarelated type A lactic acidosis and Lagerstroemia speciosarelated type B lactic acidosis. Zheng JQ, et al. Corosolic acid-induced acute kidney injury and lactic acidosis in a patient with impaired kidney function. American Journal of Kidney Diseases 56: 803039435 419-20, No. 2, Aug 2010 - Taiwan
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Editorial comment: A search of AdisBase, Embase and Medline did not reveal any previous case reports of an interaction between diclofenac and Lagerstroemia speciosa. The WHO ADR database contained no reports involving the concomitant use of diclofenac and Lagerstroemia speciosa.
0114-9954/10/1320-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 25 Sep 2010 No. 1320
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