title: A case of donepezil-related torsades de pointes.
abstract: An 80-year-old woman with Alzheimer's dementia presented with diarrhoea, vomiting and worsening confusion following an increase in donepezil dose from 5 to 10 mg. The ECG revealed prolongation of QTc interval. Soon after admission, she became unresponsive with polymorphic ventricular tachycardia (VT). Cardiopulmonary resuscitation with a 200 J shock was successful in establishing cardiac output. Following the discontinuation of donepezil, the QTc interval normalised and no further arrhythmias were recorded. Treatment with anticholinesterase inhibitors may result in life-threatening VT. Vigilance is required for the identification of this condition in patients presenting with presyncope, syncope or seizures.
authors.affiliation: Department of Cardiology, Frimley Health NHS Foundation Trust, Slough, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: Kitt
authors.affiliation: Department of Geriatrics, Royal Berkshire Hospital, Reading, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Irons
authors.affiliation: Department of Cardiology, Frimley Health NHS Foundation Trust, Slough, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Obaidi
authors.affiliation: Department of Cardiology, Frimley Health NHS Foundation Trust, Slough, UK.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Missouris
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000188:drug therapy*; D016887:Cardiopulmonary Resuscitation; D000077265:Donepezil; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007189:Indans / Q000008:administration & dosage / Q000009:adverse effects*; D008133:Long QT Syndrome / Q000139:chemically induced*; D018697:Nootropic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D012640:Seizures / Q000139:chemically induced; D013575:Syncope / Q000139:chemically induced / Q000628:therapy; D016171:Torsades de Pointes / Q000139:chemically induced*
chemical_list: D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil