Hypotension and bradycardia associated with concomitant tizanidine and lisinopril therapy

Abstract

The addition of tizanidine in a patient receiving long-term treatment with lisinopril was associated with severe hypotension and bradycardia.

Profound Symptomatic Bradycardia Requiring Transvenous Pacing After a Single Dose of Tizanidine

“…The data surrounding tizandine toxicity are sparse. A few previous case reports have described profound decreases in heart rate and blood pressure attributed to interacting medications and tizanidine initiation (2)(3)(4). We report a case of tizanidineinduced bradycardia and hypotension attributed to a single dose of medication.…”

Co‐Prescription of Strong CYP1A2 Inhibitors and the Risk of Tizanidine‐Associated Hypotension: A Retrospective Cohort Study

“…In the case reports, researchers have presented tizanidine-induced hypotension in patients with liver cirrhosis and suggest that the hypotensive episodes can be mediated by these patients' impaired CYP1A2 activity. 10 Similarly, some cases of severe hypotension are attributed to concurrent use of tizanidine and lisinopril, [11][12][13] and one of the authors acknowledged that it is unclear whether this effect is drug or class specific. 12 Our results suggest that the association between concurrent use of strong CYP1A2 inhibitors in combination with tizanidine and severe hypotension is present across all antihypertensive drugs and is directly related to the number of antihypertensive drugs prescribed.…”

Irreversible profound symptomatic bradycardia requiring pacemaker after tizanidine/loxoprofen combination therapy: a case report

“…Bradycardia as a side effect of tizanidine has been reported. 5 – 7 In such cases, the heart rate improved after tizanidine was stopped. The heart rate of this adult patient barely improved despite cessation of tizanidine.…”

“…5 There are only rare reports of bradycardia as a side effect of tizanidine at conventional doses. 6,7 In those cases, the heart rate improved after tizanidine was stopped. Another report describes a 93-year-old woman with irreversible profound symptomatic bradycardia from tizanidine.…”