title: Dofetilide in Overdose: A Case Series from Poison Center Data.
abstract: Dofetilide is a class III antiarrhythmic used for treating atrial dysrhythmias. Though its adverse effects are well described in routine use, very little is known about dofetilide toxicity in overdose. This is a retrospective case series of consecutive patients reported to our poison center after dofetilide overdose. Twenty-seven cases were included. Seventeen patients were treated at a healthcare facility, and of these, eight were admitted. Twenty-one patients took one extra capsule, four took someone else's medication, one took three extra capsules, and one had a large intentional overdose. Ten patients had co-ingestants reported, including three QT-prolonging agents. No one required cardioversion, defibrillation, CPR, or overdrive pacing. The patient who reported taking 90 times his usual dose in suicide attempt was the only patient to have significant clinical effects. He experienced an 8-beat run of non-sustained ventricular tachycardia, frequent multifocal PVCs, and ventricular bigeminy. He received magnesium sulfate and potassium chloride supplementation. In this series, unintentional small overdoses did not result in significant clinical effects and were often managed successfully at home, despite the fact that information showing a single capsule can cause torsades. This study is limited by its small sample size, retrospective design, and reliance on incomplete information.
authors: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, 1250 E. Marshall Street, 2nd Floor, Richmond, VA, 23298, USA. michellehieger@gmail.com.|Virginia Poison Center, 830 E. Main Street, Suite 300, PO Box 980522, Richmond, VA, 23298, USA. michellehieger@gmail.com.|Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA. michellehieger@gmail.com.
authors: M A
authors: MA
authors: Hieger
authors: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, 1250 E. Marshall Street, 2nd Floor, Richmond, VA, 23298, USA.|Virginia Poison Center, 830 E. Main Street, Suite 300, PO Box 980522, Richmond, VA, 23298, USA.|Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA.
authors: K F
authors: KF
authors: Maskell
authors: Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA.
authors: M J
authors: MJ
authors: Moss
authors: Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA.
authors: S W
authors: SW
authors: Powell
authors: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, 1250 E. Marshall Street, 2nd Floor, Richmond, VA, 23298, USA.|Virginia Poison Center, 830 E. Main Street, Suite 300, PO Box 980522, Richmond, VA, 23298, USA.|Department of Emergency Medicine, VCU Medical Center, Richmond, VA, 23298, USA.
authors: K L
authors: KL
authors: Cumpston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D015331:Cohort Studies; D062787:Drug Overdose / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010627:Phenethylamines / Q000009:adverse effects*; D011039:Poison Control Centers / Q000706:statistics & numerical data / Q000639:trends*; D012189:Retrospective Studies; D013223:Statistics as Topic / Q000379:methods / Q000639:trends*; D013406:Suicide, Attempted / Q000706:statistics & numerical data / Q000639:trends; D013449:Sulfonamides / Q000009:adverse effects*
chemical_list: D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; C063533:dofetilide
keywords: Antiarrhythmic; Dofetilide; Dysrhythmia; Overdose; Poison center; QTc prolongation; Tikosyn; Torsades; Ventricular tachycardia