{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T09:45:24Z","timestamp":1780479924190,"version":"3.54.1"},"reference-count":7,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,12,23]]},"abstract":"<jats:p>In the elderly, calcium-channel blockers are the first-line treatment for hypertension, and macrolides are commonly prescribed antibiotics. Here we report a 78-year-old man taking nifedipine, diltiazem and carvedilol who presented with persistent hypotension and bradycardia after clarithromycin was prescribed. He was diagnosed with drug-induced hypotension and treated with fluid resuscitation and vasoactive agents. His symptoms gradually improved. He was transferred out of the intensive care unit 3\u2005days after hospitalisation. Combining calcium-channel blockers and clarithromycin can cause vasodilatory hypotension. The concomitant use of calcium-channel blockers and macrolide antibiotics increases the levels of calcium-channel blockers in the blood as they are metabolised by cytochrome P450 3A4 (CYP3A4), which is inhibited by macrolide antibiotics. Moreover, the addition of another calcium-channel blocker and a \u03b2 blocker can lower cardiac output due to bradycardia and worsen hypotension. Therefore, it is important to consider drug interactions when the cause of hypotension is unknown.<\/jats:p>","DOI":"10.1136\/bcr-2016-218388","type":"journal-article","created":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T10:40:19Z","timestamp":1483958419000},"page":"bcr2016218388","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Hypotension induced by the concomitant use of a calcium-channel blocker and clarithromycin"],"prefix":"10.1136","volume":"2017","author":[{"given":"Sayako","family":"Takeuchi","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9532-2859","authenticated-orcid":false,"given":"Yuki","family":"Kotani","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihide","family":"Tsujimoto","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,1,9]]},"reference":[{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.284427"},{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1212055"},{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.282426"},{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.4","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1111\/jgs.13624","article-title":"A case of hypotension and bradycardia precipitated by drug interaction of clarithromycin and calcium-channel blocker","volume":"63","author":"Agrawal","year":"2015","journal-title":"J Am Geriatr Soc"},{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.5","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E496"},{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.6","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E432"},{"key":"2025082802445074000_2017.jan09_1.bcr2016218388.7","doi-asserted-by":"crossref","first-page":"408","DOI":"10.2165\/00002018-199106060-00003","article-title":"Poisoning due to calcium antagonists. Experience with verapamil, diltiazem and nifedipine","volume":"6","author":"Pearigen","year":"1991","journal-title":"Drug Safety"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-218388","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:44:59Z","timestamp":1756374299000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-218388"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,9]]},"references-count":7,"alternative-id":["10.1136\/bcr-2016-218388"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-218388","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,9]]}}}