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[Acute intestinal occlusion and calcium antagonists]
Insights
Nifedipine can cause intestinal blockages in patients with angina pectoris, even after surgery. This suggests a direct smooth muscle relaxant effect, potentially synergistic with other medications, leading to functional intestinal occlusion.
Area of Science:
- Cardiology
- Gastroenterology
- Pharmacology
Background:
- Angina pectoris is a common cardiovascular condition.
- Calcium channel blockers like diltiazem and nifedipine are frequently prescribed for angina.
- Intestinal complications are not typically associated with these medications.
Observation:
- A patient with angina pectoris experienced recurrent intestinal occlusion after nifedipine administration.
- Surgical exploration revealed no organic cause for the blockages.
- The patient was concurrently treated with diltiazem.
Findings:
- Nifedipine administration was directly correlated with the onset of intestinal occlusion.
- The absence of organic lesions indicated a functional cause.
- A synergistic effect between diltiazem and nifedipine was hypothesized.
Implications:
- Calcium channel blockers may possess direct smooth muscle relaxant properties on the intestine.
- This pharmacological action could lead to functional intestinal obstruction.
- Clinicians should consider potential gastrointestinal side effects of calcium channel blockers, especially in combination therapy.
Abstract:
A 41 years old male patient suffering from angina pectoris was treated with diltiazem (Tildiem). He was administered with nifedipine (Adalate) 3 times in succession and each time either complete or partial intestinal occlusion occurred. A laparotomy was carried out after the first occlusion, but no organic lesions were found. The search for an alternate non-drug related explanation proved negative. The most likely hypothesis is that of a direct relaxant activity on intestinal smooth muscle, which would explain the functional nature of the occlusion. Therefore it must be considered that the two drugs acted synergistically.