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Case report: pentamidine and polymorphic ventricular tachycardia revisited
S Mani1, A G Kocheril, V T Andriole
1Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06510.
The American Journal of the Medical Sciences
|April 1, 1993
Summary
Pentamidine isethionate can cause dangerous heart rhythm problems like torsade de pointes, especially with low magnesium levels. Early recognition and magnesium treatment may help manage this side effect without stopping pentamidine therapy.
Area of Science:
- Cardiology
- Pharmacology
- Infectious Diseases
Background:
- Pentamidine isethionate is an antimicrobial agent used to treat certain infections.
- Ventricular tachyarrhythmias, including torsade de pointes, have been anecdotally linked to pentamidine use.
Observation:
- This report details two new cases of pentamidine-induced torsade de pointes.
- A review of all previously reported cases was conducted to identify patterns.
Findings:
- Pentamidine-induced torsade de pointes appears to correlate with serum magnesium levels, with hypomagnesemia potentially playing a synergistic role.
- The complication typically arises after approximately 10 days of pentamidine treatment.
- No other acute adverse effects of pentamidine were noted in the observed patients.
Implications:
- Early identification of QTc interval prolongation is crucial for prompt intervention.
- Magnesium supplementation is recommended for patients exhibiting QTc prolongation during pentamidine therapy.
- Treatment of torsade de pointes may be possible without discontinuing pentamidine, emphasizing the importance of vigilant monitoring and timely management.