Ciprofloxacin/antineoplastics/antidepressants interaction
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Hypokalaemia, QTc prolongation and torsade de pointes: case report A 68-year-old woman developed hypokalaemia, QTc prolongation and torsade de pointes (TdP) following interaction of vemurafenib and cobimetinib with ciprofloxacin, mirtazapine and escitalopram [not all dosages and outcomes stated; routes and duration of treatments to reaction onsets not stated]. The woman, who had malignant melanoma, was admitted to the emergency department with recurrent short-lasting episodes of syncope. At admission, she was conscious with a normal physical examination. An ECG showed QT interval of 700ms along with frequent ventricular extrasystole (R-on-T phenomenon). Bedside echocardiography was normal without any structural heart disease. She had been receiving a combination therapy with vemurafenib and cobimetinib since 2 years for malignant melanoma along with mirtazapine 30mg since 9 months and escitalopram 20mg since one year. She was then shifted to the coronary care unit (CCU), where she was found to have recurrent R-on-T phenomenon, TdP and syncope. Her blood test showed marked hypokalaemia and elevated creatinine level, which was prevalent since past 5 months. Although she had near syncope episode since 3 months, she was prescribed ciprofloxacin for gallbladder infection. It was concluded that she developed hypokalaemia, QTc prolongation and TdP secondary to pharmacodynamic interaction of vemurafenib and cobimetinib with mirtazapine, escitalopram and ciprofloxacin. The woman’s treatment with ciprofloxacin, cobimetinib, escitalopram, mirtazapine and vemurafenib was withheld. She was followed in the CCU for 4 days with potassium replacement therapy and continuous monitoring of heart rhythm. However, her hypokalaemia persisted, and she was continued on potassium replacement therapy. Subsequently, QT interval decreased from 700ms to 500ms but was still above the normal range. Therefore, the drugs were permanently stopped and an intra-cardiac defibrillator was implanted. She was discharged on potassium replacement therapy and unspecified β-blocker. Paudel A, et al. Deciphering the role of combination therapy of cobimetinib, vemurafenib, and antidepressant drugs in qtc prolongation and torsade de pointes (Tdp) in 803502363 malignant melanoma. Journal of Oncological Science 6: 123-126, No. 2, 24 Jun 2020. Available from: URL: http://doi.org/10.37047/jos.2020-73730
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Reactions 26 Sep 2020 No. 1823
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