Prolonged quinidine half-life with associated toxicity in a patient with hepatic failure.
A markedly prolonged quinidine elimination half-life due to hepatic failure and resultant quinidine toxicity occurred in a 57-year-old man with a history of atrial fibrillation. A prolonged QT interval, development of torsades de pointes, and a serum quinidine concentration of 3.1 micrograms/ml contributed to a decision favoring permanent pacemaker implantation. The apparent quinidine half-life ranged from 66-99 hours and was associated with QT prolongation and persistent U waves. On discontinuing quinidine, all signs associated with toxicity resolved as serum quinidine concentrations decreased, which resulted in reversal of the decision to implant a permanent pacemaker. This case reports an extremely long quinidine elimination half-life and reillustrates the importance of drug pharmacokinetics in patient care.
Stanek
E J
EJ
Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy and Science, PA 19104-4495, USA.
Simko
R J
RJ
DeNofrio
D
D
Pavri
B B
BB
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D004562:Electrocardiography; D006207:Half-Life; D006801:Humans; D017093:Liver Failure / Q000150:complications / Q000378:metabolism*; D008133:Long QT Syndrome / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011802:Quinidine / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D016171:Torsades de Pointes / Q000139:chemically induced
D000889:Anti-Arrhythmia Agents; D011802:Quinidine