title: Acute on Chronic Ivabradine Overdose: a Case Report.
abstract: Ivabradine is a newly approved medication which reduces the heart rate by antagonizing the If channel. We report a case of intentional overdose on ivabradine. A 26-year-old female presented after taking 250 mg ivabradine. On arrival, her vital signs and neurologic exam were unremarkable. Within 30 min, her heart rate decreased to 31 bpm, but she remained normotensive with no change in mentation. Her bradycardia resolved after treatment with atropine. She experienced two further bradycardic episodes responsive to atropine; the second episode was associated with hypotension, responsive to a fluid bolus. For the remainder of her hospitalization, she remained hemodynamically stable without further interventions. She was dispositioned to the psychiatry service approximately 36 h post-ingestion with a heart rate of 67 bpm. Laboratory analysis confirmed a serum ivabradine concentration of 525 ng/mL, greater than 50 times the mean level in therapeutic trials. Proposed treatments for ivabradine include activated charcoal, atropine, isoproterenol, and intravenous pacing. Further study is needed to identify ideal treatment modalities.
authors: Virginia Commonwealth University Health System, Richmond, VA, USA. kevin.maskell@vcuhealth.org.
authors: Kevin
authors: K
authors: Maskell
authors: Eastern Virginia Medical School, Norfolk, VA, USA.
authors: Adele
authors: A
authors: Tse
authors: Virginia Commonwealth University Health System, Richmond, VA, USA.
authors: Carl E
authors: CE
authors: Wolf
authors: Virginia Commonwealth University Health System, Richmond, VA, USA.
authors: Michelle
authors: M
authors: Troendle
mesh_terms: D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000097:blood / Q000506:poisoning* / Q000627:therapeutic use; D001285:Atropine / Q000627:therapeutic use; D001552:Benzazepines / Q000097:blood / Q000506:poisoning* / Q000627:therapeutic use; D001919:Bradycardia / Q000209:etiology / Q000517:prevention & control; D003131:Combined Modality Therapy; D054815:Cyclic Nucleotide-Gated Cation Channels / Q000037:antagonists & inhibitors* / Q000378:metabolism; D062787:Drug Overdose / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D000077550:Ivabradine; D049990:Membrane Transport Modulators / Q000097:blood / Q000506:poisoning* / Q000627:therapeutic use; D054972:Postural Orthostatic Tachycardia Syndrome / Q000188:drug therapy; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014768:Virginia
chemical_list: D000889:Anti-Arrhythmia Agents; D001552:Benzazepines; D054815:Cyclic Nucleotide-Gated Cation Channels; D049990:Membrane Transport Modulators; D000077550:Ivabradine; D001285:Atropine
keywords: Bradycardia; Cardiotoxicant; Ivabradine