Intestinal Pseudo-Obstruction Caused by Diltiazem in a Neutropenic Patient

Abstract

Although calcium-channel blockers rarely cause intestinal pseudo-obstruction, clinicians must be aware of this serious but reversible adverse effect.

Paralytic ileus associated with use of diltiazem

“…10 With regard to the case report describing suspected diltiazem-induced intestinal pseudoobstruction, the slow resolution of symptoms after discontinuation of diltiazem and the presence of comorbidities linked with decreased GI motility (infection, neutropenia) make it difficult to infer a causal link. 11 In contrast to those case reports, the case described here clearly illustrates the potential for diltiazem to decrease intestinal motility. Paralytic ileus in our patient was temporally associated with the use of therapeutic doses of diltiazem and promptly resolved after the medication was discontinued.…”

“…The fourth case report described intestinal pseudoobstruction associated with the use of highdose diltiazem hydrochloride (480 mg daily) for ventricular rate control in a patient with atrial fibrillation and acute myelogenous leukemia. 11 Am J Health-Syst Pharm-Vol 68 Aug 1, 2011 In that patient, GI symptoms began about three days after initiation of diltiazem therapy and did not resolve until three days after the drug was discontinued; the recognition of a possible link between diltiazem use and paralytic ileus or intestinal pseudoobstruction may be complicated by the presence of infection or neutropenia, either of which may be associated with motility disorders. 1 Although the case reports described above suggest that the use of diltiazem may be associated with disorders of decreased GI motility, the definitive determination of a link between diltiazem use and the reported adverse reactions is problematic.…”

“…[1][2][3] Although not a frequently reported adverse effect, hypomotility disorders have been linked to the use of some calcium-channel blockers, including nimodipine, nifedipine, verapamil, and diltiazem. [4][5][6][7][8][9][10][11] Here we report a case of paralytic ileus in a patient with atrial fibrillation who received high-dose diltiazem therapy for the control of rapid ventricular response.…”