56
Blood Pressure Management
Table 16. Pharmacokinetic Drug-Drug Interactions With
Antihypertensive Medications
Blood Pressure Drug
Potential
Interacting Drug Clinical Effect
Metabolism (cont'd)
CYP3A4 inhibition
via amlodipine,
verapamil, or diltiazem
or other CYP3A4
inhibitors
Tacrolimus,
cyclosporine
Increased calcineurin inhibitor
concentration leading to increased
risk for side effects (eg, renal
impairment)
Dabigatran,
rivaroxaban
Increased concentration leading to
increased risk for bleeding
Atorvastatin,
simvastatin
Increased statin concentration
leading to increased risk for side
effects (eg, myopathy)
Colchicine Increased colchicine concentration
leading to increased risk for adverse
effects (eg, neuromuscular toxicity)
Eplerenone Increased risk of hypotension and
hyperkalemia
Using a lower dose of eplerenone
when combined with diltiazem
could be considered a productive
interaction, as the inhibition of
eplerenone's metabolism might
allow for lower doses to be effective,
reducing the risk of adverse effects
while maintaining efficacy
Elimination
Lithium iazide-type diuretics,
RAS blockers
Reduced lithium clearance leading
to increased lithium toxicity risk
P-glycoprotein (P-gp)
Verapamil via P-gp
inhibition
Dabigatran Reduced P-gp efflux of dabigatran
leading to increased dabigatran
levels, which results in a higher risk
of bleeding
Verapamil and
carvedilol via P-gp
inhibition
Digoxin Reduced P-gp efflux of digoxin
leading to increased digoxin levels,
resulting in a higher risk of digoxin
toxicity
BB indicates beta blocker; and P-gp, P-glycoprotein
Modified with permission from Fravel et al. Copyright © 2021 Springer Nature.
(cont'd)
