Allopurinol/famotidine/theophylline interaction
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Various toxicities: case report A 70-year-old woman developed progressive dyspnoea, diaphoresis, non-radiating chest pressure, confusion, watery diarrhoea, non-bloody non-bilious vomiting, tachycardia, ST-segment depressions in V3 and V6, elevated high sensitivity troponin, cardiac ischaemia, non-ST-segment elevation myocardial infarction (NSTEMI), episodes of non-sustained ventricular tachycardia, tremor and visual hallucinations secondary to theophylline toxicity following the concomitant administration of theophylline, allopurinol and famotidine* [routes, dosages and durations of treatments to reactions onsets not stated]. The woman presented to hospital due to progressive dyspnoea, diaphoresis and non-radiating, constant chest pressure for 3 weeks. She had some confusion, but denied cough or fever. She also had watery diarrhoea and non-bloody non-bilious vomiting 3 days prior to the presentation. Her medical history was significant for hyperlipidaemia, hypertension, asthma, deep vein thrombosis/pulmonary embolism, gastroesophageal reflux disease and gout. Her regular medications included theophylline, hydrochlorothiazide/triamterene, unspecified ICS/LABA inhaler, salbutamol [albuterol], famotidine and allopurinol. On admission, she was tachycardic, afebrile and normotensive. She was alert and oriented without neurological deficit or tremor. She had no tremor or neurological deficit. Cardiopulmonary examination was normal. ECG revealed ST-segment depressions in V3 and V6. She showed elevated high sensitivity troponin of 76 [unit not stated]. Laboratory investigations revealed the following: elevated levels of WBC, potassium 2.2, bicarbonate 15, magnesium 1, lactate 5.3 and anion gap 23 [units not stated]. Due to concern for cardiac ischaemia, the woman underwent percutaneous coronary intervention which showed mild diffuse disease without discrete lesions. She did not have evidence of critical stenosis on percutaneous coronary intervention, suggestive of a type II NSTEMI due to increased cardiac demand. Post-catheterisation, she developed visual hallucinations, tremor and episodes of non-sustained ventricular tachycardia. Due to her clinical status change, theophylline level was obtained and found to be critically elevated at 31.8 [unit not stated]. She was transferred to the ICU and underwent emergent dialysis, after which her symptoms resolved. * Country of occurrence, reporter country and primary source country not stated. This abstract was presented at CHEST Annual Meeting on 18–21 October 2020. Cashy C, et al. THEOPHYLLINE TOXICITY MASQUERADING AS CARDIAC ISCHEMIA IN A 70-YEAR-OLD FEMALE. Chest 158 (Suppl.): A1679 (plus poster), No. 803511148 4, Oct 2020. Available from: URL: http://doi.org/10.1016/j.chest.2020.08.1503 [abstract]
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Reactions 31 Oct 2020 No. 1828
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