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Related Experiment Videos

Miconazole-induced fatal dysrhythmia

K C Coley1, J L Crain

  • 1University of Pittsburgh Medical Center, Center for Education and Research in Therapeutics, PA 15213, USA.

Pharmacotherapy
|March 1, 1997
PubMed
Summary

Intravenous miconazole can cause severe cardiac arrhythmias, including bradyarrhythmia and ventricular fibrillation, particularly in heart transplant patients. Caution is advised when administering this antifungal agent to individuals with pre-existing heart conditions.

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Area of Science:

  • Mycology
  • Pharmacology
  • Cardiology

Background:

  • Miconazole is an imidazole antifungal agent with topical, vaginal, and parenteral formulations.
  • Parenteral miconazole use is infrequent due to newer, more effective antifungal agents.
  • Scopulariopsis infections can occur in immunocompromised individuals, such as heart transplant recipients.

Observation:

  • A 54-year-old heart transplant patient developed a disseminated subcutaneous Scopulariopsis infection.
  • The infection persisted despite treatment with amphotericin B and itraconazole.
  • Intravenous miconazole was administered as salvage therapy.

Findings:

  • The patient experienced bradyarrhythmia during intravenous miconazole infusion, which resolved upon discontinuation.

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  • Rechallenge with a lower dose of intravenous miconazole led to recurrent bradyarrhythmia, progressing to ventricular fibrillation.
  • Miconazole-induced cardiac arrhythmias are rare, often linked to administration factors like rapid infusion, inadequate dilution, or the drug vehicle.

    • Implications:

    • Intravenous miconazole administration requires extreme caution in patients with underlying heart disease.
    • This case highlights a potential severe adverse cardiac event associated with intravenous miconazole.
    • Further investigation into the cardiac safety profile of parenteral miconazole is warranted, especially in vulnerable patient populations.