持続型nifedipine製剤により急性呼吸不全を呈した1例

A case of acute respiratory failure precipitated by long-acting nifedipine

　近年，高血圧症や虚血性心疾患の治療にCa拮抗薬が繁用されるようになり，患者のコンプライアンスや安定した薬効の維持などの面で，持続型製剤を用いる機会も増えてきた。

　持続型nifedipine製剤は，その強力かつ持続的な体・冠血管の拡張作用から，重症高血圧症にも適用され，比較的安定した降圧効果の期待できる薬剤の一つとして評価されている。

A 76 year-old man with hypertension and diabetes mellitus was admitted to the department of ophthal-mology of our hospital for the operation of cataract.

His hypertension had been poorly controled with α-methyldopa and diltiazem, so we used nifedipine 10 mg cap at need and got a sufficient control. Therefore a long acting nifedipine 20 mg (Adalat-L®) twice daily was substituted for diltiazem.

In the following three days he had a sudden onset of general fatigue with fever, skin eruption and liver dysfunction, moreover difficulty in breathing and hypoxemia became more and more severe. Chest X-ray disclosed bilateral streaky, reticulo macular shadow, namely the findings of pulmonary edema.

We considered these abnormalities were based on allergic reactions, then stopped all drugs and started steroid medication. Fortunately he had gradually recovered from all symptoms.

We held the lymphocyte stimulating test for all drugs, and found out Adalat L tab. was the only positive drug, especially its coating substance had high score.

We conclude that pulmonary edema of this case developed because of increasing permiability on pul-monary vascular bed, due to allergic response to Adalat L tab., with the background of tendency to easily fall into hemodynamic imbalance which was based on atherosclerosis.