Wednesday, January 19, 2011

CAUTION ; UNAPPRECIATED SEVERE SIDE EFFECTS OF SOME CARDIAC DRUGS

Over the last week, two of our cardiac drugs have been reported with serious side effects.

1. In the first report last week, Sanofi Aventis reported that they have reports of severe liver toxicity with their new anti-arrhythmic, dronedarone. This is a rare side effect, but can be serious. Two of the liver failures resulted in liver transplantation. Dronedarone is the new anti-Atrial fibrillation agent that is in the process of being launch in Malaysia. The FDA has just ( 17th Jan. 2011 ) issued a letter of safety communication, on this side effect of dronedarone. The timing is certainly awkward for Sanofi Aventis in Malaysia.

2. The Jan 17th online edition of the Canadian Medical Association carried a publication, senior author Dr Alissa Wright and Dr David Juurlink, of the occurrence of hypotension requiring hospitalisation resulting from the use of a macrolide antibiotic in patients also on a calcium channel blocker. They recommended that Erythromycin and clarithromycin, should not be used together with a CCB, as this may result in clinically significant hypotension. If we need to use a macrolide with a CCB, the better choice of a macrolide antibiotic is azithromycin. This is because of the metabolism pathway. Both macrolide antibiotics ( except azithromycin ), and CCB are metabolised through the cytochrome PY450, and the macrolide antibiotic prolongs the metabolism of the CCB by inhibiting the enzyme. Since CCB is very commonly used anti-hypertensive agent, especially in Malaysia, this is worth remembering. I only wonder about all the other drugs that are also metabolised by CYP450 ( and there are many ), for example the statins, will they also interfere with the metabolism of the CCB. A timely word of caution when prescribing a drug. Obviously, if the patient does not need a drug. do not use it. Can mild incidental labile hypertension with no target organ damage, be treated with life style modification, weight loss, no added salt diet, green veges and fruits?

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