Verapamil
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Cardiotoxicity in an elderly patient: case report A 76-year-old woman with previously undiagnosed renal failure developed cardiotoxicity during treatment with verapamil for hypertension. The woman, whose regular medication included verapamil 480 mg/day, furosemide and gliclazide, presented with severe hypotension, bradycardia and diaphoresis [time to reaction onset not stated]. The woman received atropine and epinephrine [adrenaline]. An ECG showed marked bradyarrhythmia. Verapamil toxicity was considered, but an ischaemic episode was presumed, and treatment with enoxaparin sodium, aspirin and atorvastatin was commenced. Laboratory findings revealed elevated levels of urea, serum creatinine, magnesium and phosphate. Arterial blood gas analysis found a pH of 7.26, with increased pCO2 and decreased pO2. Left ventricular hypertrophy was evident on echocardiography. Calcium gluconate was administered and, within a few minutes, she developed atrial fibrillation (AF). Her recovery was complicated by further AF requiring metoprolol, but she was discharged after 4 days with normal laboratory parameters and without symptoms. Author comment: "Since magnesium and verapamil both block the calcium channels in the cardiac muscle, their actions may be additive or synergistic . . . this mechanism could have led to severe bradyarrhythmia in our patient despite ‘therapeutic’ doses of verapamil and mildly elevated magnesium levels." Jadhav PP, et al. Cardiotoxicity of verapamil in renal failure: A case report and review of the literature. Cases Journal 2: No. 9, Sep 2009. Available from: URL: 803021869 http://dx.doi.org/10.4076/1757-1626-2-6312 - Australia
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Reactions 26 Jun 2010 No. 1307
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