Exacerbation of atrioventricular block associated with concomitant use of amlodipine and aprepitant in a lung cancer patient: A case report.

Hideyuki Hibino, Yoshinori Makino, Naomi Sakiyama, Reiko Makihara-Ando, Hironobu Hashimoto, Takeshi Akiyoshi, Ayuko Imaoka, Yutaka Fujiwara, Yuichiro Ohe, Masakazu Yamaguchi, Hisakazu Ohtani

International journal of clinical pharmacology and therapeutics 2021 Apr

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To report a case of second-degree atrioventricular block associated with concomitant use of aprepitant and amlodipine. A 73-year-old man with lung cancer was treated with aprepitant for prophylactic use for the prevention of nausea and vomiting, concomitantly with cisplatin, gemcitabine, and an investigational drug (anti-epidermal growth factor receptor monoclonal antibody). He was diagnosed with first-degree atrioventricular block and was taking amlodipine for hypertension. During the first cycle of chemotherapy, 5 days after the start of aprepitant, he experienced Wenckebach second-degree atrioventricular block (Mobitz type I), and amlodipine was discontinued. After day 6, the atrioventricular block was not shown. According to the Naranjo adverse drug reaction scale, a score of 7 was obtained (causality: probable). In addition, using the Drug Interaction Probability Scale, a score of 6 was obtained (causality: probable). The drug-drug interaction between aprepitant and amlodipine was considered to have deteriorated his atrioventricular block, conceivably due to the inhibition of cytochrome P450 (CYP) 3A-mediated metabolism of amlodipine by aprepitant.

Citation

Hideyuki Hibino, Yoshinori Makino, Naomi Sakiyama, Reiko Makihara-Ando, Hironobu Hashimoto, Takeshi Akiyoshi, Ayuko Imaoka, Yutaka Fujiwara, Yuichiro Ohe, Masakazu Yamaguchi, Hisakazu Ohtani. Exacerbation of atrioventricular block associated with concomitant use of amlodipine and aprepitant in a lung cancer patient: A case report. International journal of clinical pharmacology and therapeutics. 2021 Apr;59(4):328-332