From the Literature

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From the Literature Case ReportsContents 1. Antiallergics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 2. Antineoplastics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269 3. Antivirals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 4. Cardiovascular Therapies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272 5. Immunosuppressants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 6. Neurologic and Psychiatric Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 7. News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

1. Antiallergics Hydroxyzine: Syncope, QT-Interval Prolongation, and Torsade de Pointes: Case Report

A 34-year-old woman developed syncope, QT-interval prolongation, and torsade de pointes during treatment with hydroxyzine for chronic pruligo [sic]. The woman started receiving hydroxyzine 75 mg/day and, 3 days later, developed repetitive syncope and was admitted to hospital; she had a history of presyncopal attack of unknown origin. On admission, an ECG showed a QT-interval prolongation of 640 ms (QTc 630 ms). Her syncope was suspected to be related to torsade de pointes. Hydroxyzine was discontinued on admission. She experienced no further syncope. Three weeks after the episode, her QT interval had gradually shortened to 460 ms (QTc 464 ms). A drug-induced extreme prolongation of the QT interval was considered likely. Subsequent genetic testing revealed that she had a heterozygous A614-human ether-a-go-go-related gene (HERG) mutation. Author comment: ‘‘In our patient, both genetic background and female sex are definite risk factors to trigger QT prolongation. In addition, hydroxyzine intake produced a ‘‘double hit’’, leading to a reduction in cardiac ‘‘repolarization reserve’’ and a severe phenotype, presumably [torsade de pointes].’’

Sakaguchi T, Itoh H, Ding W-G, et al. Hydroxyzine, a first generation H1-receptor antagonist, inhibits human ether-a-go-go-related gene (HERG) current and causes syncope in a patient with the HERG mutati

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