QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kao, C.-D. Articles by Liao, K.-K. Search for Related Content PubMed PubMed Citation Articles by Kao, C.-D. Articles by Liao, K.-K.

Hypotension Due to Interaction Between Lisinopril and Tizanidine

Fellow, Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; Clinical Lecturer, Department of Neurology, National Yang Ming University School of Medicine, Taipei; Attending Physician, Department of Neurology, Puli Veterans Hospital, Nantou, Taiwan

Jiun-Bin Chang, MD

Senior Resident, Department of Neurology, Taipei Veterans General Hospital; Clinical Teaching Assistant, Department of Neurology, National Yang Ming University School of Medicine

Jen-Tse Chen, MD

Fellow, Department of Neurology, Taipei Veterans General Hospital; Assistant Professor, Department of Neurology, National Yang Ming University School of Medicine; Attending Physician, Department of Neurology, Cathay General Hospital, Taipei

Zin-An Wu, MD

Chief, Department of Neurology, Taipei Veterans General Hospital; Chief, Department of Neurology, National Yang Ming University School of Medicine

Din-E Shan, MD PhD

Attending Physician, Department of Neurology, Taipei Veterans General Hospital; Professor, Department of Neurology, National Yang Ming University School of Medicine

Kwong-Kum Liao, MD

Attending Physician, Department of Neurology, Taipei Veterans General Hospital; Clinical Associate Professor, Department of Neurology, National Yang Ming University School of Medicine

Reprints: Kwong-Kum Liao MD, Department of Neurology, Taipei Veterans General Hospital, 201, Sec. II, Shih-Pai Rd., Peitou District, Taipei, Taiwan 11217, fax 886-2-28757584, kkliao{at}vghtpe.gov.tw

OBJECTIVE: To report a case in which significant hypotension occurred after initiation of tizanidine in a patient using the antihypertensive agent lisinopril.

CASE SUMMARY: A 48-year-old woman was admitted due to cerebral hemorrhage at the midbrain and pons, with extension to the fourth ventricle. Consciousness disturbance (Glasgow coma scale 4) with a decerebrate posture improved 5 days after stroke onset. As the BP was fairly high, antihypertensive agents, including lisinopril, were initiated. Three weeks later, the decerebrate rigidity and high BP remained, and tizanidine was initiated to see whether the decrease in muscle tone could facilitate hypertension control and motor recovery. However, the BP dropped dramatically within 2 hours after the first dose of tizanidine. The tizanidine and all of the antihypertensive medications were withdrawn. Tizanidine was used again after her BP had stabilized, but did not produce similar problems.

DISCUSSION: A similar event was reported in 2000. The reaction in our patient appeared after tizanidine initiation and improved after both lisinopril and tizanidine were discontinued. According to the Naranjo probability scale, this was classified as a possible drug interaction. This kind of reaction is seldom mentioned as occurring during co-administration with tizanidine. With its characteristics, tizanidine has the potential to compromise hemodynamic stability during concomitant angiotensin-converting enzyme inhibitor use.

CONCLUSIONS: Based upon the literature review, the hypotension in this patient was possibly due to the interaction between tizanidine and lisinopril.

Key Words: ACEI, hypotension, lisinopril, tizanidine

Published Online, September 21, 2004. www.theannals.com, DOI 10.1345/aph.1E161

This article has been cited by other articles:

				H. Zhou Population-based assessments of clinical drug-drug interactions: qualitative indices or quantitative measures? J. Clin. Pharmacol., November 1, 2006; 46(11): 1268 - 1289. [Abstract] [Full Text] [PDF]