Medroxyprogesterone
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Torsades de pointes (first report) in a patient with long QT syndrome: case report A woman with congenital type 2 long QT syndrome developed torsades de pointes while receiving medroxyprogesterone [Depo-Provera] for postpartum contraception. The 19-year-old woman, who had an implantable cardioverter defibrillator (ICD), received IM depot medroxyprogesterone 150mg [frequency not stated] after delivering her first child. Four weeks postpartum, she experienced a ventricular fibrillation/torsades de pointesterminating ICD shock. She manifested a syncopal episode precipitated by torsades de pointes 3 days later, which spontaneously reverted to sinus rhythm. She was advised to cease medroxyprogesterone and started β-adrenergic receptor antagonist therapy, which she later discontinued due to depression, mood change and fatigue. Following the birth of her second child at 23 years of age, the woman immediately resumed IM medroxyprogesterone 150mg and received a total of five injections at 3-month intervals. β-adrenergic receptor antagonist therapy, which had been restarted during pregnancy, was withdrawn 6 months postpartum due to side effects. Almost a year after giving birth, she experienced a brief episode of spontaneously terminating ventricular tachycardia, followed by two brief episodes over 1 month later; an ICD shock was delivered during the second ventricular fibrillation-initiated syncopal episode. She discontinued medroxyprogesterone, and eventually underwent left cardiac sympathetic denervation. She had no further cardiac events over 6 years of follow-up and did not restart medroxyprogesterone. Author comment: "[T]he presence of synthetic [medroxyprogesterone], and the patient’s decision to forego beta-blocker pharmacotherapy may have contributed to her increased risk of events . . . when she was receiving [medroxyprogesterone] injections." Giudicessi JR, et al. Potential depot medroxyprogesterone acetate-triggered torsades de pointes in a case of congenital type 2 long QT syndrome. Heart Rhythm 9: 1143-1147, No. 7, Jul 2012. Available from: URL: http:// 803075908 dx.doi.org/10.1016/j.hrthm.2012.02.006 - USA
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Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of torsades de pointes associated with medroxyprogesterone. The WHO ADR database contained 1 report of torsade de pointes associated with medroxyprogesterone.
0114-9954/10/1416-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 25 Aug 2012 No. 1416
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