title: Slow junctional rhythm, QTc prolongation and transient torsades de-pointes following combined use of Ivabradine, Diltiazem and Ranolazine.
abstract: A case of unstable angina developed slow junctional rhythm with QTc prolongation and transient Torsades de pointes following simultaneous use of Ivabradine, Diltiazem and Ranolazine. Effect of Diltiazem on hepatic isoenzyme CYP 3A could be responsible. Such a combination should be avoided.
authors.forename: S R
authors.initials: SR
authors.lastname: Mittal
mesh_terms: D000083:Acetanilides / Q000009:adverse effects* / Q000627:therapeutic use; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000188:drug therapy*; D001552:Benzazepines / Q000009:adverse effects* / Q000627:therapeutic use; D001919:Bradycardia / Q000139:chemically induced* / Q000175:diagnosis; D004110:Diltiazem / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects*; D005260:Female; D006801:Humans; D000077550:Ivabradine; D008133:Long QT Syndrome / Q000139:chemically induced* / Q000175:diagnosis; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D000069458:Ranolazine; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D000083:Acetanilides; D001552:Benzazepines; D010879:Piperazines; D000077550:Ivabradine; D000069458:Ranolazine; D004110:Diltiazem