QT prolongation and torsade de pointes associated with solifenacin in an 81‐year‐old woman

Abstract

Solifenacin, an antimuscarinic drug, has been widely used for the treatment of overactive bladder (OAB), but severe cardiac adverse effects have not been reported. An 81-year-old woman was prescribed solifenacin 5 mg day -1 for OAB. Two weeks later she developed the first syncope. Nine days after the first syncope she developed recurrent syncope, and electrocardiogram monitoring showed marked QT prolongation and torsade de pointes (TdP). Concomitant drugs remained unchanged. Serum electrolytes and hepatic function were normal. Calculated creatinine clearance was mildly decreased. We considered that the loss of consciousness was associated with solifenacin. Although intravenous magnesium sulphate could not terminate the recurrence of TdP, increasing the pacing rate prevented further attacks of TdP. Solifenacin might be a possible cause of QT prolongation and TdP.Solifenacin is a newer bladder-selective antimuscarinic drug for the treatment of OAB [1]. Although terodiline, an older antimuscarinic drug for OAB, has been reported to predispose to QT prolongation and TdP and was withdrawn from the market in the early 1990s [2-4], solifenacin has not been reported to have severe cardiac adverse effects [1].An 81-year-old woman was admitted to the division of orthopaedics with dislocation of hip joint and infection of decubitus. One year before admission she had undergone total hip arthroplasty. Her past medical history included hypertension and pacemaker implantation for sick sinus syndrome. Her medication included amlodipine, but not any over-the-counter drugs or herbals. Electrocardiogram (ECG) on admission showed sinus rhythm with normal QT interval (QT400 ms/QTc360 ms) (Figure 1a). Solifenacin 5 mg day -1 was started for OAB after admission. Her infection was initially treated with intravenous cefazolin, but was changed to intravenous teicoplanin because of methicillin-resistant Staphylococcus aureus infection. Two weeks later she suddenly developed loss of consciousness, but she spontaneously regained full consciousness.Although ECG was not recorded during the episode, ECG monitoring showed QT prolongation (QT600 ms/ QTc581 ms) after regaining consciousness (Figure 1b). Nine days after the first syncope she developed recurrent loss of consciousness and ECG monitoring showed TdP (Figure 1c). She was resuscitated with a single DC shock. She was immediately transferred to the division of cardiology. ECG monitoring showed QT prolongation (QT600 ms) and recurrent TdP. Serum electrolytes and hepatic function were normal. Calculated creatinine clearance was 60 ml min -1 . We considered that solifenacin was closely related to syncope and TdP. We stopped solifenacin. Intravenous magnesium sulphate could not terminate recurrent episodes of TdP. The pacing rate was increased 60 to 90 beats min -1 to shorten the QT interval, resulting in a QT interval of 600 to 500 ms (QTc 408 ms). There were no further attacks of TdP. Electrocardiographic abnormalities resolved a few days after solifenacin was discontinued.The high bladder ...

Torsade de pointes associated with the combination of solifenacin and clenbuterol for urinary incontinence

“…Solifenacin has not been shown to have severe adverse cardiac effects, although another antimuscarinic agent, telodiline, has been reported to cause QT prolongation and TdP [2,3,8]. However, Asajima et al [9] reported a case of solifenacin-induced TdP associated with QT prolongation. The case was an 81-year-old woman who was on 5 mg/day solifenacin when TdP appeared.…”

Cardiac effects of muscarinic receptor antagonists used for voiding dysfunction

“…QT prolongation and torsade de pointes associated with solifenacin in an 81‐year old woman was reported by Asajima et al . [87].…”

Treatment of Overactive Bladder in Elderly Patients: Clinical Considerations

“…The prolongation of QT interval and development of serious tachyarrhythmias such as polymorphic ventricular tachycardia (torsade de pointes) have also been reported. 37 Some antimuscarinics (tolterodine, fesoterodine, propiverine, trospium) have been demonstrated in randomized controlled trials to increase heart rate, 38,39 but its clinical relevance is not yet determined. Does this suggest that we may be exposing patients to hidden cardiac risk due to the intake of antimuscarinic drugs prescribed for a "benign" disease such as OAB?…”