QT-Interval Prolongation Associated with Supratherapeutic Guanfacine Concentration: A Case Report.

IF 2.5 4区医学 Q3 TOXICOLOGY

Journal of Medical Toxicology Pub Date : 2024-04-01 Epub Date: 2024-01-17 DOI:10.1007/s13181-023-00986-8

Fumiya Inoue, Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba, Akira Namera

{"title":"QT-Interval Prolongation Associated with Supratherapeutic Guanfacine Concentration: A Case Report.","authors":"Fumiya Inoue, Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba, Akira Namera","doi":"10.1007/s13181-023-00986-8","DOIUrl":null,"url":null,"abstract":"Introduction: Guanfacine, an alpha-2 adrenergic agonist, is used to treat attention deficit hyperactivity disorder (ADHD). Although cardiovascular effects including hypotension and bradycardia are common adverse effects of guanfacine, the effect of guanfacine on QT intervals remains unclear. The association between the serum concentration of guanfacine and its toxicity has also not been fully investigated.Case report: This is a case of a 21-year-old woman with ADHD who developed repeated presyncope 1 day before admission. She was taking 3 mg of extended-release guanfacine and 50 mg of sertraline. On admission, she had bradycardia and hypotension. An electrocardiogram (ECG) showed a QT interval of 0.68 s and a QTcF interval of 0.648 s. The QT intervals were manually measured and corrected by the Fridericia formula (QTcF = QT/RR1/3). Although she denied taking an overdose of guanfacine and other drugs, we suspected guanfacine toxicity. The serum guanfacine concentration was 13.0 ng/mL on admission and decreased to 3.2 ng/mL on day 1 and 0.4 ng/mL on day 2. Changes in QTcF intervals and her vital signs correlated with serum guanfacine concentrations.Conclusion: Supratherapeutic serum guanfacine concentrations may induce QT prolongation.","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959869/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Toxicology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13181-023-00986-8","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"TOXICOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction: Guanfacine, an alpha-2 adrenergic agonist, is used to treat attention deficit hyperactivity disorder (ADHD). Although cardiovascular effects including hypotension and bradycardia are common adverse effects of guanfacine, the effect of guanfacine on QT intervals remains unclear. The association between the serum concentration of guanfacine and its toxicity has also not been fully investigated.

Case report: This is a case of a 21-year-old woman with ADHD who developed repeated presyncope 1 day before admission. She was taking 3 mg of extended-release guanfacine and 50 mg of sertraline. On admission, she had bradycardia and hypotension. An electrocardiogram (ECG) showed a QT interval of 0.68 s and a QTcF interval of 0.648 s. The QT intervals were manually measured and corrected by the Fridericia formula (QTcF = QT/RR^1/3). Although she denied taking an overdose of guanfacine and other drugs, we suspected guanfacine toxicity. The serum guanfacine concentration was 13.0 ng/mL on admission and decreased to 3.2 ng/mL on day 1 and 0.4 ng/mL on day 2. Changes in QTcF intervals and her vital signs correlated with serum guanfacine concentrations.

Conclusion: Supratherapeutic serum guanfacine concentrations may induce QT prolongation.

查看原文本刊更多论文

QT间期延长与治疗浓度过高的关法辛有关：病例报告。

简介关法辛（Guanfacine）是一种α-2肾上腺素能激动剂，用于治疗注意力缺陷多动障碍（ADHD）。尽管包括低血压和心动过缓在内的心血管效应是关法辛常见的不良反应，但关法辛对 QT 间期的影响仍不清楚。关法辛的血清浓度与其毒性之间的关系也尚未得到充分研究：这是一个 21 岁女性多动症患者的病例，她在入院前 1 天出现反复晕厥。她正在服用 3 毫克的胍法辛缓释片和 50 毫克的舍曲林。入院时，她出现心动过缓和低血压。心电图显示 QT 间期为 0.68 秒，QTcF 间期为 0.648 秒。虽然她否认服用了过量的关法辛和其他药物，但我们怀疑她服用了关法辛中毒。入院时血清中的鸟氨酸浓度为 13.0 纳克/毫升，第 1 天降至 3.2 纳克/毫升，第 2 天降至 0.4 纳克/毫升。QTcF间期和生命体征的变化与血清中的关法辛浓度相关：结论：超治疗浓度的血清关法辛可能会诱发QT延长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Medical Toxicology TOXICOLOGY-

CiteScore

5.40

自引率

10.30%

发文量

期刊介绍： Journal of Medical Toxicology (JMT) is a peer-reviewed medical journal dedicated to advances in clinical toxicology, focusing on the diagnosis, management, and prevention of poisoning and other adverse health effects resulting from medications, chemicals, occupational and environmental substances, and biological hazards. As the official journal of the American College of Medical Toxicology (ACMT), JMT is managed by an editorial board of clinicians as well as scientists and thus publishes research that is relevant to medical toxicologists, emergency physicians, critical care specialists, pediatricians, pre-hospital providers, occupational physicians, substance abuse experts, veterinary toxicologists, and policy makers. JMT articles generate considerable interest in the lay media, with 2016 JMT articles cited by various social media sites, the Boston Globe, and the Washington Post among others. For questions or comments about the journal, please contact jmtinfo@acmt.net. For questions or comments about the journal, please contact jmtinfo@acmt.net.