Domperidone/lacosamide

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Domperidone/lacosamide QTc interval prolongation and ventricular fibrillation: case report

A 38-year-old woman developed QTc interval prolongation on domperidone and ventricular fibrillation following concomitance administration of domperidone and lacosamide for tonic-clonic seizures. The woman, who had a history of persistent vegetative status due to cerebral hemorrhage, with myocardial hypertrophy and hypertension and without prior dysrhythmias, was transferred to the hospital for a ventriculo-peritoneal shunt placement. Her medication regimen consisted of levetiracetam. Her surgical procedure was uneventful but 12 hours later, she developed sudden onset generalized tonic-clonic seizures. Valproate was started, but the BP decreased to 70/46mmHg; moreover hyperammonemia 122 µmol/L was recorded during valproate therapy. Therefore, she was switched to IV lacosamide 400mg infusion 3 times/day. In the meantime, gastric retention was observed and domperidone 10mg every 8 hours [route not stated] was started. After the second dose of domperidone, the QTc interval increased from 460ms to 503ms and the drug was stopped. Six hours after the last domperidone administration, she received the third dose of lacosamide, however, soon after an episode of ventricular tachycardia occurred, followed by 27 episodes of life-threatening ventricular fibrillation requiring cardioversion at 200 J over the next 12 hours. The woman’s treatment with lacosamide was discontinued. All the cardiac conduction abnormalities had resolved. The lacosamide concentration 48 hours after the last dose was 12.9 mg/L. Two months later, she was subsequently discharged from the hospital without further cardiac arrhythmias. Eleftheriou G, et al. Lacosamide-induced recurrent ventricular fibrillation. Clinical Toxicology 58: 606-607, No. 6, Jan 2020. Available from: URL: http:// doi.org/10.1080/15563650.2020.1741981 [abstract]

0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

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Reactions 26 Sep 2020 No. 1823

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