Complete heart block in chronic chloroquine poisoning

Ladipo, G. O. A.; Essien, Emmanuel E.; Andy, Joseph J.

doi:10.1016/0167-5273(83)90136-5

Cited by 35 publications

(22 citation statements)

References 4 publications

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“…Heart conduction disturbances secondary to antimalarial long-term treatment have been described in 45 patients [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] and may include bundle-branch block and atrioventricular block (table 1). AVB may be associated with syncope and often requires the insertion of a pacemaker.…”

Section: Discussionmentioning

confidence: 99%

“…However, rare but severe toxic effects may develop following prolonged use of these treatments. These side effects include retinopathy, toxic neuropathy, vacuolar myopathy and/or cardiotoxicity [1] with both heart conduction disturbances [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29] and congestive heart failure (CHF) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,30,31,32,33]. These cardiac toxic effects, described both singly or in combination, have been reported with CQ [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28, 30, 31] and less frequently with HCQ use alone [1,2,3,4, 29, 32, 33].…”

Section: Introductionmentioning

confidence: 99%

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Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

Costédoat-Chalumeau¹,

Hulot

Amoura³

et al. 2006

Cardiology

106

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The antimalarial agents, chloroquine (CQ) and hydroxychloroquine (HCQ) are used in long-term treatment of connective tissue diseases and dermatological disorders and are generally regarded as safe. We present one case of cardiotoxicity in a 59-year-old woman treated with antimalarials during 13 years for a discoid lupus erythematosus. She progressively developed conduction disturbances and congestive heart failure (CHF). When the diagnosis of antimalarials toxicity was suspected, CQ was withdrawn. However, heart transplantation had to be performed in the following 4 months for severe CHF. Indeed, rare but severe cardiotoxicity may develop following prolonged use of antimalarials with both conduction disturbances (45 patients) and CHF (25 patients). These cardiac toxic effects have been reported with CQ and less frequently with HCQ use alone. Diagnoses are often delayed since the toxicity of the drug might be misattributed to other factors in these patients. The endomyocardial biopsy, or in some cases the muscle biopsy, are essential to confirm the antimalarials toxicity. Antimalarials have been stopped in 12 cases of CHF, leading to improvement in 8 cases (within 3 months to 5 years) and to deaths or to heart transplantation in 4 cases (within 1 week to 3 months). In the latter cases, as in our patient, the lack of improvement may have been explained by the severity of the cardiomyopathy at diagnosis and the short delay since withdrawal. As a consequence, the potential for reversibility and the severity in undiagnosed cases of these toxic cardiomyopathies emphasize the importance of recognizing early signs of toxicity in order to withdraw antimalarials before the occurrence of life-threatening CHF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

Costédoat-Chalumeau¹,

Hulot

Amoura³

et al. 2006

Cardiology

106

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“…The data quality is also variable because of small subject numbers in each study (1)(2)(3)(4)(5)(6)(7)(8)(9)(10), and wide variability in drug measurements per subject (13)(14)(15)(16)(17). Only three studies used AUC data to estimate milk Cavg.…”

Section: Discussionmentioning

confidence: 99%

“…Given these in vitro and pharmacokinetic data, it is likely that DECQ is an important contributor to overall CQ efficacy, especially where parasite resistance to CQ is prevalent. Nevertheless, IC50 values may not predict in vivo response reliably, while DECQassociated cardiotoxicity is of potential concern given that previous studies have demonstrated cardiotoxicity for CQ and the closely related di-desethylCQ [2,3].…”

Section: Introductionmentioning

confidence: 99%

Transfer of chloroquine and desethylchloroquine across the placenta and into milk in Melanesian mothers

Law

Ilett

Hackett

et al. 2008

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The literature on placental and milk transfer of chloroquine and its major bioactive metabolite desethylchloroquine is sparse and incomplete. WHAT THIS STUDY ADDS• We have provided data on the transplacental transfer of chloroquine and desethylchloroquine in Melanesian women (n = 19), measured transfer of these drugs into breast milk (n = 16) and estimated absolute and relative infant doses for the breastfed infant.• The data for desethylchloroquine are novel.• In all three areas we have significantly increased both quantity and quality of the available database. AIMSTo investigate the transfer of chloroquine and its major bioactive metabolite desethylchloroquine across the placenta and into breast milk. METHODSIn Papua New Guinea, chloroquine (CQ; 25 mg base kg ) is recommended for prophylaxis of malaria during pregnancy, and at the Alexishafen Health Centre women are routinely prescribed CQ at the time of delivery. Fetal-cord and maternal serum samples were collected at delivery (n = 19) and milk samples were collected from day 3 to day 17-21 after delivery (n = 16). CQ and its primary active metabolite desethylchloroquine (DECQ) were quantified by high-performance liquid chromatography. For both CQ and DECQ cord/maternal ratios (C/M) were calculated to characterize placental transfer, and infant exposure via milk was estimated by standard methods. RESULTSThe median (interquartile range) C/M was 1.1 (0.9, 1.6) for CQ and 1.2 (0.5, 1.8) for DECQ. The average concentration in milk over the time of sampling was 167 mg l -1 (27, 340) for CQ and 54 mg l -1 (22, 106) for DECQ. Estimated absolute and relative infant doses were 34 mg kg -1 day -1 (7, 50) and 15 mg kg -1 day -1 (4, 26), and 2.3% (0.5, 3.6) and 1.0% (0.4, 2.0) for CQ and DECQ (as CQ equivalents), respectively. CONCLUSIONInfant exposure to CQ and DECQ during pregnancy will be similar to that in the maternal circulation, and dependent on maternal dose and frequency. The median CQ + DECQ relative infant dose of 3.2% (as CQ equivalents) was low, confirming that use of CQ during lactation is compatible with breastfeeding.

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“…However, in many reported cases, secondary causes of conduction disturbances were not excluded such as coronary artery disease or myocardial dysfunction in angiography or echocardiography examination. In previous reports, chloroquine had been taken for many years before the development of heart block, which was irreversible and required pacemaker implant (11)(12)(13). Conversely, we suggest that this patient's transient AVB was related to her chloroquine therapy.…”

Section: Discussionmentioning

confidence: 51%

Klorokin Tedavisine Bağlı Üçüncü Derece Atriyoventriküler Blok

İslamoğlu¹,

Yazıcı²,

Çil³

et al. 2011

Tftr

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A 67-year-old woman on long-term chloroquine treatment for rheumatoid arthritis presented with dizziness and syncope. Although her medical history revealed no cardiovascular disease, complete atrioventricular block was detected by electrocardiography. Chloroquine was discontinued. Three days later, complete atrioventricular block spontaneously resolved to sinus rhythm. Cardiac complications associated with chronic chloroquine use are uncommon, nevertheless, there have been several reports on potential lifethreatening rhythm disturbances and/or cardiomyopathy. In our case, atrioventricular block was associated with chronic chloroquine use. Cardiac evaluation with electrocardiography must be done for conduction disorders in patients using chloroquine for rheumatic diseases.

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Complete heart block in chronic chloroquine poisoning

Cited by 35 publications

References 4 publications

Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

Cardiomyopathy Related to Antimalarial Therapy with Illustrative Case Report

Transfer of chloroquine and desethylchloroquine across the placenta and into milk in Melanesian mothers

Klorokin Tedavisine Bağlı Üçüncü Derece Atriyoventriküler Blok

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