Magnesium hydroxide/verapamil
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Junctional bradycardia: case report An 89-year-old woman developed junctional bradycardia during concomitant treatment with magnesium hydroxide for chronic constipation and verapamil for hypertension [routes not stated; not all dosages stated]. The woman presented to the emergency department (ED) after a fall. On arrival to ED the vital signs were normal except HR of 51 beats per minute (BPM). An ECG revealed junctional bradycardia with a ventricular rate of 50 BPM. Laboratory investigations showed an increased level of magnesium, creatinine of 1.62 mg/dL, potassium of 4.5 mmol/L, blood urea nitrogen of 46 mg/dL, calcium of 9.0 mg/dL and a glomerular filtration rate (GFR) of 28 mL/min/ body surface area. It was reported that, recently she had increased the use of magnesium hydroxide [milk of magnesia] for chronic constipation. Anamnesis revealed that she had an ED visit 1 month prior due to increased systolic BP (hypertension). During this time, she was discharged with an increase in verapamil dose from 240mg daily to 280mg daily. Based on these findings and clinical presentation it was concluded that the synergistic action of the verapamil and magnesium hydroxide (drug interaction) resulted in the junctional bradycardia [durations of treatments to reaction onset not stated]. Subsequently, the woman was hospitalised, and treated with calcium gluconate and IV fluids. On admission, her treatment with verapamil was discontinued. One hour after the treatment the ventricular rate had improved to 65BPM and four hours later it was 79BPM. On the next morning, an ECG revealed sinus rhythm at a ventricular rate of 76BPM. Prior to discharge, she started receiving treatment with losartan for hypertension. Saunders H, et al. Escalating the dose and downgrading the rhythm: the combination of prescribed and non-prescribed medications resulting in an abnormal heart rhythm. Age and Ageing : 2020. Available from: URL: http://doi.org/10.1093/ageing/afaa114 803499075
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Reactions 5 Sep 2020 No. 1820
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