Hypotension due to interaction between lisinopril and tizanidine

The Annals of Pharmacotherapy
Chuen-Der KaoKwong-Kum Liao

Abstract

To report a case in which significant hypotension occurred after initiation of tizanidine in a patient using the antihypertensive agent lisinopril. 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 The tizanidine and all of the antihypertensive medications were withdrawn.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. 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 occurr...Continue Reading

References

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Citations

Aug 16, 2006·Expert Opinion on Drug Safety·Huifang Cheng, Raymond C Harris
Dec 3, 2014·The Journal of Emergency Medicine·Jennifer CortesDanyelle Redden
Sep 18, 2018·Clinical Pharmacology and Therapeutics·Sandip ChaugaiCecilia P Chung
Sep 21, 2010·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Susan W Publow, Donald L Branam

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