Grapefruit-thiazide interaction

Dr. Kyriacou urges you to reconsider your answer. The presentation and labs fit rhabdomyolysis with acute kidney injury, suggested by severe myalgia, marked creatine kinase elevation, and a rise in creatinine. Hydrochlorothiazide is not significantly metabolized by CYP3A4, which metabolizes grapefruit juice, so grapefruit does not meaningfully raise its levels. If there was inhibition of thiazide metabolism, you would expect electrolyte disturbances, for example hypokalemia, that may produce cramps or weakness. Thiazides do not typically cause marked creatine kinase elevation and myoglobin‑mediated kidney injury. 

Please go back and re-consider. 

Presentation

Map: Mattias Garcia_UNIC (1092)
Node: 20632
Score:

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  • Glycerol trinitrate
  • Furosemide (loop diuretic)
  • Glycerol trinitrate (organic nitrate)
  • Emergency Department
  • Furosemide (loop diuretic)
  • Emergency Department
  • Bisoprolol
  • Presentation
  • Dobutamine
  • Grapefruit-aspirin interaction
  • Hypersensitivity reaction to medication
  • Grapefruit-thiazide interaction

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