Fatal Propafenone Overdoses: Case Reports and A Review of the Literature

Clarot, F.; Goulle, J.; Horst, Marlène; Vaz, Elenice Maria Cecchetti; Lacroix, Christian; Proust, B.

doi:10.1093/jat/27.8.595

Cited by 33 publications

(44 citation statements)

References 11 publications

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“…He was managed with respiratory support, administration of hypertonic (8.4%) sodium bicarbonate, hypertonic (1.8%) sodium, glucagon, magnesium, epinephrine/norepinephrine and DC cardioversion. There are a number of previous reports of propafenone poisoning, with similar life-threatening symptoms in which cardiac features predominate with QRS/QTc prolongation and ventricular arrhythmias [11,[13][14][15][16][17]. However, seizures have been reported in one case of severe propafenone poisoning [16].…”

Section: Discussionmentioning

confidence: 99%

Propafenone Poisoning—A Case Report with Plasma Propafenone Concentrations

et al. 2010

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Propafenone is an anti-arrhythmic drug used in the management of supraventricular and ventricular arrhythmias. It is metabolised through cytochrome P450 2D6 pathways; the major metabolites possess antiarrhythmic activity. The cytochrome P450 CYP2D6 is coded by more than 70 alleles resulting in great genetic polymorphism of CYP2D6 isoenzymes, and up to 7% of Caucasian population are poor metabolisers. This case report describes a patient with severe overdose of propafenone who presented with coma, seizures and cardiotoxicity. The patient was managed with intravenous glucagon, hypertonic sodium bicarbonate, hypertonic saline and inotropic support. The propafenone and its 5-hydroxypropafenone (5-OHP) metabolite were measured by high-performance liquid chromatography with ultraviolet detection (no assay was available at the time to measure N-despropyl propafenone concentrations). Toxicological screen showed propafenone concentrations at a maximum of 1.26 mg/L at 9-10 h post-presentation, falling to 0.25 mg/L at 27-28 h postpresentation. No propafenone metabolite 5-OHP was detected in any sample analysed. No antidepressant or analgesic drugs were detected in toxicological screen. Propafenone overdose has been reported to be associated with features of severe cardiovascular and CNS toxicity. Aggressive treatment, meticulous monitoring and supportive care was associated with a good outcome in this case.

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Section: Discussionmentioning

confidence: 99%

Propafenone Poisoning—A Case Report with Plasma Propafenone Concentrations

et al. 2010

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“…As a result, propafenone shortens the effective refractory period, exerts a ß-adrenoceptor blocking action, and has a calcium antagonistic activity (4). Propafenone overdose is not a common situation, and a few cases of lethal self-poisoning have been reported in the literature (2). We present a case of cardiopulmonary arrest after propafenone intoxication in a patient with normal cardiovascular function.…”

Section: Introductionmentioning

confidence: 95%

“…After the approval by the Food and Drug Administration, the use of propafenone was started in the United States in 1989. Propafenone usage has been restricted since 1990 because of life-threatening ventricular arrhythmias that increased mortality (2). Class IC antiarrhythmic drugs cause QRS prolongation without QT prolongation.…”

Section: Introductionmentioning

confidence: 99%

Clinical Management of Severe Propafenone Intoxication

Kara¹,

Çelik²,

Apilioğulları³

et al. 2015

Erciyes Med J

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We present a case of cardiopulmonary arrest after propafenone intoxication in a patient with normal cardiovascular function. She was admitted to the critical care unit within 40 min after 9000 mg propafenone consumption. Main findings were cardiac arrest, instable hemodynamics, and atrioventricular junction block. For its management, transient pacing was performed with catecholamine infusion. We achieved a good outcome in this case because of rapid resuscitation and aggressive treatment with monitoring and supportive care, including mechanical ventilation.

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“…[1] It is an agent used in patients with symptomatic supraventricular tachycardia requiring treatment such as atrioventricular (AV) node tachycardia and paroxysmal atrial fibrillation. It is also used in life-threatining symptomatic ventricular tachycardia requiring treatment.…”

Section: Introductionmentioning

confidence: 99%

“…[3,4] Even though propafenone is a widely used class 1C antiarrhytmic, cases of fatal acute propafenone intake are rarely reported in the literature. [1] In this report, we present a case of excess propafenone hydrocloride (HCl) intake with suicidal purpose and we aim to share our experience with malign arrhytmia development and arrhytmia management.…”

Section: Introductionmentioning

confidence: 99%

Malign Arrhytmia Development Due To Propafenone Over Dose: A Case Report

et al. 2012

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ÖZET SUMMARYPropafenone is a group 1C antiarrhytmic agent. It is an agent used in patients with symptomatic supraventricular tachycardia requiring treatment, such as atrioventricular node tachycardia, Wolff-Parkinson-White Syndrome and paroxysmal atrial fibrillation. It is also used in life-threatining symptomatic ventricular tachycardia requiring treatment and with excessive intake it has serious side effects on cardiovascular, gastrointestinal, nervous, haematological and dermatological systems. In this report, we present a case of propafenone intake with suicidal purpose and we aim to share our experience with malign arrhytmia development and arrhytmia management. A 22-year-old female patient presented to our emergency department with complaints of general situation distortion and feeling sick after ingesting 20 pills (6 g) of her friend's Propafenone HCl 300 mg for suicidal purpose one hour previously. In the electrocardiography (ECG), regular rhythm, wide QRS and the absence of P-wave was observed. Pulseless ventricular tachycardia developed and defibrillation with 360 joule was performed followed by cardiopulmonary resuscitation. NaHCO 3 administration of 1 mEq/kg every 4 hours was initiated. After the therapy, QRS duration shortened. The patient became conscious with spontaneous ventilation. Early diagnosis and appropriate resuscitative interventions can be vital in propafenone intoxication. NaHCO 3 administration in the presence of hypotension and ECG abnormalities are vital.

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Fatal Propafenone Overdoses: Case Reports and A Review of the Literature

Cited by 33 publications

References 11 publications

Propafenone Poisoning—A Case Report with Plasma Propafenone Concentrations

Propafenone Poisoning—A Case Report with Plasma Propafenone Concentrations

Clinical Management of Severe Propafenone Intoxication

Malign Arrhytmia Development Due To Propafenone Over Dose: A Case Report

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