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Fatal intoxication with ivabradine: First case report
A Knapp-Gisclon1, M Zerah1, C Mayer-Duverneuil1
1Laboratoire de Pharmacologie - Toxicologie, Centre Hospitalier Universitaire Raymond Poincaré, AP-HP, 104 boulevard Raymond Poincaré, 92380, Garches, France.
Forensic Science International
|April 21, 2020
Summary
This case study details the first reported fatal overdose of ivabradine, a heart medication. Post-mortem analysis revealed high concentrations of ivabradine in blood and organs, contributing to multiple organ failure.
Area of Science:
- Forensic Toxicology
- Clinical Pharmacology
- Cardiology
Background:
- Ivabradine is a widely prescribed bradycardic agent for chronic stable angina and heart failure.
- Drug overdose cases require accurate quantification of substances in biological matrices for toxicological assessment.
Observation:
- A 61-year-old woman presented with drowsiness, severe bradycardia (45 bpm), and hypotension following an overdose.
- Despite medical intervention, the patient succumbed to multiple organ failure approximately ten hours after admission.
Findings:
- A validated LC-MS/MS method quantified ivabradine in post-mortem samples.
- Elevated ivabradine concentrations were found in blood (1210 ng/mL) and various organs, including lung (2910 ng/g) and kidney (1510 ng/g).
- Co-ingestion of pregabalin (50 μg/mL) and zopiclone (206 ng/mL) was also detected.
Implications:
- This case represents the first documented fatal intoxication involving ivabradine.
- The study provides crucial reference concentrations of ivabradine in post-mortem biological samples and organs.
- Findings highlight the potential for severe toxicity with ivabradine overdose, especially in combination with other central nervous system depressants.
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