Poisoning with oral antiarrhythmic drugs

The incidence of poisoning with antiarrhythmic drugs (AAD) is low, but frequently cardiac disturbances cause a high mortality. Clinical and toxicological data on verapamil, quinidine, ajmaline, prajmaliumbitartrate, mexiletine and aprindine as collected by the Austrian Poison Information Center (PIC) are presented in this paper. The drug concentrations of verapamil, mexiletine and quinidine detected in post-mortem specimens are discussed and compared with correspondent data from literature. Clinical experiences with this kind of intoxication are rather poor and therapeutical principles are very inconsistent. To avoid life-threatening symptoms, gastric lavage has to be performed irrespective of the latency period, accompanied by continuous cardiac monitoring. Cardiocirculatory disorders respond well to sympathomimetic drugs. Immediate and adequate cardiopulmonary resuscitation decisively determines the therapeutical success in critical cases.