Torsades de Pointes induced by a combination of garenoxacin and disopyramide and other cytochrome P450, family 3, subfamily A polypeptide-4-influencing drugs during hypokalemia due to licorice

Abstract

We report an 82-year-old man who developed ventricular tachycardia and Torsades de Pointes (TdP) after oral administration of garenoxacin, a novel quinolone antibiotic agent that differs from the third-generation quinolones, for pneumonia. He had hypokalemia (K 2.3 mmol/L) induced by licorice and also had received disopyramide for arrhythmia, bicalutamide for prostate cancer, and silodosin for prostate hypertrophy. After taking him off all drugs and administering spironolactone supplemented with potassium, his low serum potassium level was ameliorated. Therefore, although garenoxacin reportedly causes fewer adverse reactions for cardiac rhythms than third-generation quinolone antibiotics, one must be cautious of the interference of other drugs during hypokalemia in order to prevent TdP.

Pharmacological Effects ofGlycyrrhizaspp. and Its Bioactive Constituents: Update and Review

“…Some side effects associated with licorice extract consumption Side effects References Neurologic Thunderclap headache Chatterjee et al, 2010; van Beers et al, 2011 RCVS-PRES Chatterjee et al, 2010 PERS Morgan et al, 2011 Carpal tunnel syndrome Tacconi et al, 2009 Cardiovascular Cardiac arrest Crean et al, 2009; Yorgun et al, 2010 Hypertension Henderson et al, 2010; Ruiz-Granados et al, 2012 Edema Johns, 2009; Caubet-Kamar et al, 2010 Endocrine PseudohyperaldosteronismPseudohyperaldosteronism(Imtiaz, 2011;Kishimoto et al, 2011;Robles et al, 2013) HypokalemiaHenderson et al, 2010;Miyamoto et al, 2010;Chen et al, 2011; Dehours et al, 2013 …”

Electrical storm induced by hypokalemia associated with herbal medicines containing licorice

“…Only a few case reports have described this event in the western countries. [8][9][10][11][12] Licorice has been used as a food additive (sweetener), in cosmetics, and in herbal remedies in traditional Korean medicine for a long time. The active component of licorice is glycyrrhetinic acid, which inhibits the enzyme 11β-hydroxysteroid dehydrogenase.…”

Torsades de pointes induced by garenoxacin in association with pacing failure in an elderly woman with VDD pacemaker

“…Although QT-prolonging effects of garenoxacin seem to be lower than the other fluoroquinolones, there has been reported one case with garenoxacin-induced TdP [5]. An 82-year-old man had TdP after oral administration of garenoxacin for pneumonia.…”