title: Lesson of the month 1: Acute flecainide overdose and the potential utility of lipid emulsion therapy.
abstract: Lipid-emulsion therapy (Intralipid®) has been advocated as a potential treatment for the management of cardio-toxicity arising from lipid-soluble drugs, particularly those acting upon sodium channels. This, on the basis of a number of ex vivo studies and animal models, suggests that partitioning a drug into lipid could alter its pharmacokinetics and result in significant clinical improvements. Its subsequent use in clinical case series has been seen as confirmation of this mechanism of action. While there are undoubtedly instances where lipid emulsion therapy has been associated with a desirable outcome in humans, as described in this case report, clinicians are reminded that they should not attribute causality, on this basis alone.
authors.affiliation: King's Health Partner, King's College Hospital, London, UK o.mukhtar@nhs.net.
authors.forename: Omar
authors.initials: O
authors.lastname: Mukhtar
authors.affiliation: Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK.
authors.forename: John Rh
authors.initials: JR
authors.lastname: Archer
authors.affiliation: Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK, and King's College London, London, UK.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Dargan
authors.affiliation: Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust and King's Health Partners, London, UK, and King's College London, London, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D062787:Drug Overdose / Q000188:drug therapy*; D004655:Emulsions / Q000627:therapeutic use; D005260:Female; D005424:Flecainide / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D006801:Humans; D010743:Phospholipids / Q000627:therapeutic use*; D013024:Soybean Oil / Q000627:therapeutic use*
chemical_list: D004655:Emulsions; D010743:Phospholipids; C545823:soybean oil, phospholipid emulsion; D013024:Soybean Oil; D005424:Flecainide
keywords: Flecainide; Intralipid; lipid emulsion therapy; overdose; toxicity