Cardiovascular Collapse Case Resulting from the Interaction Between Verapamil and Colchicine at Therapeutic Doses

Abstract

Drug-drug interactions are a significant concern, particularly in polypharmacy patients, as they increase mortality risk. This case report presents a life-threatening cardiovascular collapse resulting from the interaction of verapamil and colchicine used at therapeutic doses. The patient's clinical course was analyzed in detail, considering toxicological evaluation and the pharmacokinetic and pharmacodynamic properties of the drugs. It is thought that verapamil-induced CYP3A4 and P-glycoprotein inhibition led to elevated colchicine serum levels and toxicity. This condition posed diagnostic challenges by presenting symptoms overlapping with the cardiovascular effects of colchicine toxicity. Through effective management of the severe clinical condition caused by the drug interaction, the patient was stabilized and recovered. This case highlights the clinical significance of drug-drug interactions, even at therapeutic doses, and underscores the necessity of meticulous patient monitoring.

Keywords

• Drug-drug interactions
• Colchicine toxicity
• Verapamil
• Polypharmacy

Terapötik Dozlardaki Verapamil ve Kolşisin Etkileşimi Sonucu Görülen Kardiyovasküler Kollaps Olgusu

Öz

İlaç-ilaç etkileşimleri, özellikle polifarmasi hastalarında mortalite riskini artıran önemli bir sorundur. Bu olgu sunumunda, terapötik dozlarda kullanılan verapamil ve kolşisinin etkileşimi sonucunda yaşamı tehdit eden bir kardiyovasküler kollaps vakası bildirilmiştir. Hastanın klinik seyri; toksikolojik değerlendirme, ilaçların farmakokinetik ve farmakodinamik özellikleri göz önünde bulundurularak detaylıca analiz edilmiştir. Verapamilin CYP3A4 ve p-glikoprotein inhibisyonu nedeniyle kolşisin serum düzeylerinde artış ve toksisiteye yol açtığı düşünülmektedir. Bu durum, kolşisin toksisitesinin kardiyovasküler etkileri ile örtüşen belirtiler sunarak tanıda zorluklara neden olmuştur. İlaç etkileşimlerinin neden olduğu ağır klinik tablonun etkin yönetimi ile hasta stabil hale getirilmiş ve iyileşme sağlanmıştır. Bu vaka, terapötik dozlarda dahi ilaç-ilaç etkileşimlerinin klinik açıdan önemini ve dikkatli hasta takibinin gerekliliğini vurgulamaktadır.

Anahtar Kelimeler

• İlaç-ilaç etkileşimleri
• Kolşisin toksisitesi
• Verapamil
• Polifarmasi

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