Cardiotoxicity Induced by a Single Oral Therapeutic Dose of Verapamil in a Patient with End-Stage Renal Disease and Liver Cirrhosis

This paper describes a rare case of severe cardiotoxicity induced by only a single therapeutic dose of verapamil. A literature review of verapamil toxicity placing special emphasis on patients with renal and hepatic dysfunction is also included to disclose the potential dangers associated with the use of verapamil in these patients. A 60-year-old male with end-stage renal disease and liver cirrhosis but without any pre-existing sinus node or atrioventricular conduction dysfunction developed acute bradycardia and shock after taking a single dose of sustained-release verapamil 120 mg for the treatment of hypertension. Complete 12-lead electrocardiogram showed junctional escape rhythm. The causality was assessed by the Naranjo algorithm and a score of 6 indicated a probable relationship. He did not respond well to 0.9% normal saline fluid challenge, atropine and dopamine, but was successfully resuscitated with the use of a temporary transvenous pacemaker and recovered uneventfully. It is speculated that toxicity of this single low therapeutic dose, which in the present case mimicked the severe symptoms of massive overdose, might be related to end-stage renal disease (ESRD)-induced reductions in not only renal but also non renal clearance of verapamil on the nondialysis day. It is suggested that even though verapamil still has its role in various clinical indications, prudent benefit-risk assessment should be made before its use in these special populations.

並列關鍵字

cardiotoxicity ； end-stage renal disease (ESRD) ； liver cirrhosis ； verapamil

參考文獻

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國際替代計量

Cardiotoxicity Induced by a Single Oral Therapeutic Dose of Verapamil in a Patient with End-Stage Renal Disease and Liver Cirrhosis

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