Drugs or dissection? Unraveling a diagnostic puzzle in the ED: A case report on Tizanidine-Nifedipine interaction.

Q1 Environmental Science
Toxicology Reports Pub Date : 2025-05-27 eCollection Date: 2025-06-01 DOI:10.1016/j.toxrep.2025.102055
Muhammad Abd Ur Rehman, Maaz Uddin Mohammed, Muhammad Abdul Mannan, Waleed Salem
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Abstract

Lower back pain is among the top ten reasons patients visit the emergency department (ED). Tizanidine, a centrally acting alpha-2 adrenergic receptor agonist, is commonly prescribed for managing spasticity in patients with cerebral or spinal injuries. It is also used as an effective treatment for nonspecific lower back pain. One of the most critical and life-threatening causes of lower back pain is abdominal aortic dissection, particularly in patients with hypertension. Nifedipine, a 1,4-dihydropyridine calcium channel blocker (CCB), is a widely used oral antihypertensive and antianginal agent. It lowers systemic vascular resistance and dilates coronary arteries by inhibiting calcium ion (Ca²⁺) entry into the smooth muscle cells of small arteries (arterioles), thereby reducing systemic blood pressure and improving myocardial oxygen delivery. We report a compelling case of a male patient presenting to the ED with high blood pressure and lower back pain. Shortly after the administration of tizanidine and nifedipine, his blood pressure dropped significantly within an hour. Initially suspected to be a ruptured abdominal aortic dissection, the cause was later identified as a drug-drug interaction. The synergistic effects of tizanidine and nifedipine resulted in a rapid and critical drop in blood pressure. The Drug Interaction Probability Scale (DIPS) score of 4 suggests the hypotensive episode was possibly caused by a drug interaction. This case also highlights the importance of point of care ultrasound (POCUS) and repeated examinations in excluding life-threatening conditions like aortic rupture.

药物还是解剖?在急诊科解开一个诊断难题:蒂扎尼与硝苯地平相互作用的病例报告。
下背部疼痛是患者去急诊科(ED)的十大原因之一。替扎尼定是一种中枢作用的α -2肾上腺素能受体激动剂,通常用于治疗脑或脊髓损伤患者的痉挛。它也被用作非特异性腰痛的有效治疗方法。腹主动脉夹层是导致下背部疼痛的最关键和最危及生命的原因之一,尤其是高血压患者。硝苯地平是一种1,4-二氢吡啶钙通道阻滞剂(CCB),是一种广泛使用的口服抗高血压和抗心绞痛药物。它通过抑制钙离子(Ca 2 +)进入小动脉(小动脉)的平滑肌细胞,降低全身血管阻力,扩张冠状动脉,从而降低全身血压,改善心肌供氧。我们报告一个令人信服的情况下,男性患者提出了ED与高血压和腰痛。在给予替扎尼定和硝苯地平后不久,他的血压在一小时内显著下降。最初怀疑是腹主动脉夹层破裂,后来确定为药物相互作用。替扎尼定和硝苯地平的协同作用导致血压迅速和临界下降。药物相互作用概率量表(DIPS)得分为4分提示低血压发作可能是由药物相互作用引起的。该病例也强调了护理点超声(POCUS)和反复检查在排除危及生命的疾病(如主动脉破裂)中的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Toxicology Reports
Toxicology Reports Environmental Science-Health, Toxicology and Mutagenesis
CiteScore
7.60
自引率
0.00%
发文量
228
审稿时长
11 weeks
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