Paranoid psychosis and myoclonus: flecainide toxicity in renal failure.
Flecainide is a sodium channel blocker used mainly in the treatment of supraventricular arrhythmias. Central nervous system side effects such as dizziness, visual disturbances, headache and nausea are commonly associated with flecainide, but severe central nervous system toxicity is rare. We report the first case of flecainide toxicity in a patient with end-stage renal failure. Cessation of flecainide therapy resulted in a fall in serum flecainide levels, with associated resolution of adverse central nervous system effects. We also review the pharmacokinetics of flecainide in patients with chronic kidney disease.
Ting
Stephen M S
SM
Department of Nephrology and Transplantation, Guy's and St Thomas's NHS Foundation Trust, London, UK. stephenting@doctors.org.uk
Lee
Douglas
D
Maclean
Douglas
D
Sheerin
Neil S
NS
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005424:Flecainide / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D009207:Myoclonus / Q000139:chemically induced* / Q000503:physiopathology; D010259:Paranoid Disorders / Q000139:chemically induced* / Q000503:physiopathology; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods; D018570:Risk Assessment
D000889:Anti-Arrhythmia Agents; D007004:Hypoglycemic Agents; D005424:Flecainide