Transl Clin Pharmacol.  2015 Dec;23(2):46-48. 10.12793/tcp.2015.23.2.46.

Serious adverse events during clinical trial for pharmacokinetic interaction between telmisartan and chlorthalidone in healthy Korean subjects: A case report

Affiliations
  • 1Department of Biomedical Science, BK21 Plus KNU Bio-Medical Convergence Program for Creative Talent and Clinical Trial Center, Kyungpook National University Graduate School and Hospital, Daegu 41944, Republic of Korea.
  • 2College of Pharmacy, Yeungnam University, 280 Daehak-ro, Gyeongsan, Gyeongbuk 42415, Republic of Korea. mslim@ynu.ac.kr

Abstract

Telmisartan is an angiotensin II receptor antagonist and chlorthalidone is a thiazide-like diuretics. In this study, we report serious adverse events (SAEs) during clinical trial for pharmacokinetic interaction between telmisartan and chlorthalidone in healthy Korean subjects. Two separate, randomized, multiple-dose, two-period, one-sequence studies were conducted at Kyungpook National University Hospital. In part A, 43 volunteers received telmisartan for 7 days, and then chlorthalidone for 14 days (days 8-21). Telmisartan was co-administered during day 15-21 to evaluate the effects of chlorthalidone on the pharmacokinetics of telmisartan at steady state. A healthy 36-year-old male in part A was referred to the emergency room due to severe nausea and vomiting developed about 3 h after administration of chlorthalidone on day 9. Hypokalemia and QT prolongation were observed during his initial laboratory examination and electrocardiogram (ECG) monitoring in the emergency unit. Nausea and vomiting improved after conservative management with hospitalization for 9 days. We consider that the episodes of excessive nausea and vomiting resulted in hypokalemic state which was potentiated by chlorthalidone. And the hypokalemic state caused the lengthening of the QT interval on ECG.

Keyword

Telmisartan; Chlorthalidone; Serious adverse event (SAE); Nausea; Arrhythmia

MeSH Terms

Adult
Arrhythmias, Cardiac
Chlorthalidone*
Diuretics
Electrocardiography
Emergency Service, Hospital
Gyeongsangbuk-do
Hospitalization
Humans
Hypokalemia
Male
Nausea
Pharmacokinetics
Receptors, Angiotensin
Volunteers
Vomiting
Chlorthalidone
Diuretics
Receptors, Angiotensin

Reference

References

1. Maillard MP, Burnier M. Is the fixed-dose combination of telmisartan and hydrochlorothiazide a good approach to treat hypertension? Vasc Health Risk Manag. 2007; 3:265–278.
2. Carter BL, Ernst ME, Cohen JD. Hydrochlorothiazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension. 2003; 43:4–9.
3. Leong RW, Chan FK. Drug-induced side effects affecting the gastrointestinal tract. Expert Opin Drug Saf. 2006; 5:585–592.
Article
4. Naylor RJ, Inall FC. The physiology and pharmacology of postoperative nausea and vomiting. Anesthesia. 1994; 49(Supple):2–5.
Article
5. Kretzing S, Abraham G, Seiwert B, Ungemach FR, Krügel U, Teichert J, et al. In vivo assessment of antiemetic drugs and mechanism of lycorine-induced nausea and emesis. Arch Toxicol. 2011; 85:1565–1573. doi: 10.1007/s00204-011-0719-9.
Article
6. Yamada T, Tanaka N, Yokoi K, Ishikawa N, Seya T, Horiba K, et al. Substance P and anticancer drug-induced emesis. Gan To Kagaku Ryoho. 2007; 34:903–906.
7. Digby G, MacHaalany J, Malik P, Methot M, Simpson CS, Redfearn D, et al. Multifactorial QT interval prolongation. Cardiol J. 2010; 17:184–188.
8. Marinella MA, Burdette SD. Visual diagnosis in emergency medicine. Hypokalemia-induced QT interval prolongation. J Emerg Med. 2000; 19:375–376.
9. Kannankeril PJ, Norris KJ, Carter S, Roden DM. Factors affecting the degree of QT prolongation with drug challenge in a large cohort of normal volunteers. Heart Rhythm. 2011; 8:1530–1534. doi: 10.1016/j.hrthm.2011.03. 042.
Article
10. Sica DA, Carter B, Cushman W. Thiazide and loop diuretics. J Clin Hypertens. 2011; 13:639–643. doi: 10.1111/j.1751-7176.2011.00512.x.
Article
11. Cheungpasitporn W, Suksaranjit P, Chanprasert S. Pathophysiology of vomiting-induced hypokalemia and diagnostic approach. Am J Emerg Med. 2012; 30:384. doi: 10.1016/j.ajem.2011.10.005.
Article
12. Taira CA, Opezzo JAW, Mayer MA, Höcht C. Cardiovascular drugs inducing QT prolongations: facts and evidence. Curr Drug Saf. 2010; 5:65–72.
13. Ayad RF, Assar MD, Simpson L, Garner JB, Schussler JM. Causes and management of drug-induced long QT syndrome. Proc (Bayl Univ Med Cent). 2010; 23:250–255.
Article
14. Johnson JA, Cavallari LH, Beitelshees AL, Lewis JP, Shuldiner AR, Roden DM. Pharmacogenomics: application to the management of cardiovascular disease. Clin Pharmacol Ther. 2011; 90:519–531. doi: 10.1038/clpt.2011. 179.
Article
Full Text Links
  • TCP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr