Failure of Haemoperfusion to Reduce Flecainide Intoxication

Braun, J.; Kollert, J. R.; Gessler, U; Becker, Joshua

doi:10.1007/bf03259879

Cited by 6 publications

(2 citation statements)

References 11 publications

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“…Haemoperfusion has had conflicting results, but is an unlikely strategy, as haemoperfusion is only able to remove significant quantities of drug that have a small volume of distribution. It has the additional concern of causing hypocalcaemia and potentially further prolonging the QTc 10,11 …”

Section: Discussionmentioning

confidence: 99%

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Managing cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy

Devin

Garrett

Anstey

2007

Emerg Medicine Australasia

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Flecainide overdose can rapidly result in profound cardiovascular collapse, and is associated with a relatively high mortality. A case is described where a woman with major toxicity and high serum levels was managed without recourse to invasive modalities such as cardiopulmonary bypass or extracorporeal therapies. Hypertonic sodium bicarbonate is recognized as effective therapy for hypotension and arrhythmias. More recent case reports have concentrated on the use of cardiopulmonary bypass. In this report and other reports describing successful resuscitation, the total dose of sodium bicarbonate is conspicuously higher than in reports describing extracorporeal interventions. Sodium bicarbonate should be given early in the resuscitation, and re-administered as frequently as required, targeting an alkaline pH and improved cardiac output, while accepting hypernatraemia. This case demonstrates the maxim that the correct dose of hypertonic sodium bicarbonate is 'enough'. Cardiopulmonary bypass support can be considered as a salvage therapy.

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Section: Discussionmentioning

confidence: 99%

“…It has the additional concern of causing hypocalcaemia and potentially further prolonging the QTc. 10,11 Hypertonic sodium bicarbonate appears to improve haemodynamic instability resulting from flecainide toxicity. As illustrated in this case, the benefit can be dramatic and occur within minutes.…”

Section: Discussionmentioning

confidence: 99%

Managing cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy

Devin

Garrett

Anstey

2007

Emerg Medicine Australasia

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Altered flecainide disposition in healthy volunteers taking quinine

Munafo

Reymond-Michel

Biollaz

1990

Eur J Clin Pharmacol

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The pharmacokinetics of flecainide and its two sequential metabolites, both free and conjugated, its pharmacodynamics, and the influence of simultaneously administered quinine, have been studied in 10 healthy subjects. The study comprised two, 48-h open phases at an interval of 1 week. Flecainide acetate 150 mg was given as a 30-min i.v. infusion and quinine sulphate orally 500 mg x 3 over 24 h. Quinine administration did not change the apparent volume of distribution or the renal clearance of flecainide, but it significantly reduced its systemic clearance (9.1 vs 7.6 ml.kg-1.min-1), thus increasing the elimination half-life (9.6 vs 11.5 h). The amount of flecainide transformed to its first, meta-O-dealkylated metabolite (MODF) fell with no change in the renal excretion of the latter, either in its free or conjugated forms. This finding, in association with a fall in amount of the second, meta-O-dealkylated lactam metabolite (MODLF) recovered in its conjugated forms in the urine, suggests that quinine inhibits both the first and the second steps of the sequential metabolism of flecainide. When the subjects received quinine in addition to flecainide, the PR interval in the ECG was slightly more prolonged than with flecainide alone. Due to the study design, an effect of quinine per se and the consequence of increased serum flecainide levels could not be distinguished.

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Primary and secondary detoxification in severe flecainide intoxication

1991

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Since experience with primary and secondary detoxification in severe flecainide intoxications is limited, 2 different cases of flecainide intoxications are reported. In the first case, with plasma concentrations of 6500 ng/ml (therapeutic range: 200-980 ng/ml), the patient survived with a pacemaker and catecholamine support. In the second case, hemoperfusion terminated the need for emergency resuscitation during the initial phase, but was unsuccessful 3 h later. Even with a lower plasma concentration the patient died. Both patients had rapid onset of symptoms due to the very good bioavailability of the drug. Although it may be a rare intoxication, it is dangerous because of its quick onset and its efficiency in altering the cardiac stability. We recommend the prophylactic use of a pacemaker and gastric suction. The usefulness of hemoperfusion has not yet been proven.

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Failure of Haemoperfusion to Reduce Flecainide Intoxication

Cited by 6 publications

References 11 publications

Managing cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy

Managing cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy

Altered flecainide disposition in healthy volunteers taking quinine

Primary and secondary detoxification in severe flecainide intoxication

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