Antidysrhythmic Toxicity Medication

  • Author: Joshua B Gaither, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Nov 21, 2011
 

Medication Summary

Discontinuation of the precipitating drug is of paramount importance.

Next

GI decontaminants

Class Summary

Empirically used to minimize systemic absorption of the toxin.

View full drug information

Activated charcoal (Liqui-Char)

 

Prevents absorption by adsorbing drug in intestine. Multidose charcoal may interrupt enterohepatic recirculation and enhance elimination by enterocapillary exsorption. Theoretically, by constantly bathing the GI tract with charcoal, the intestinal lumen serves as a dialysis membrane for reverse absorption of drug from intestinal villous capillary blood into intestine. Supply as an aqueous mixture or in combination with a cathartic (usually sorbitol 70%).

Previous
Next

Cardiovascular agents

Class Summary

Alter the electrophysiologic mechanisms responsible for arrhythmia.

View full drug information

Calcium chloride

 

Moderates nerve and muscle-performance by regulating action potential excitation threshold.

View full drug information

Magnesium sulfate

 

Acts as antiarrhythmic agent and diminishes frequency of PVCs, particularly when secondary to acute ischemia.

Deficiency in this electrolyte is associated with sudden cardiac death and can precipitate refractory VF. Magnesium supplementation is used for treatment of torsade de pointes, known or suspected hypomagnesemia, or severe refractory VF.

View full drug information

Norepinephrine (Levophed)

 

DOC. Vasopressors are indicated for persistent hypotension not responsive to judicious fluid loading and sodium bicarbonate.

Previous
Next

Benzodiazepines

Class Summary

By increasing action of GABA, a major inhibitory neurotransmitter, may depress all levels of CNS, including limbic and reticular formation.

View full drug information

Diazepam (Valium)

 

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Third-line agent for agitation or seizures because of shorter duration of anticonvulsive effects and accumulation of active metabolites that may prolong sedation.

View full drug information

Lorazepam (Ativan)

 

DOC for treatment of status epilepticus because persists in the CNS longer than diazepam. Rate of injection should not exceed 2 mg/min. May administer IM if unable to obtain vascular access.

View full drug information

Midazolam (Versed)

 

Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Joshua B Gaither, MD  Fellow in Emergency Medicine Services, Prehospital and Disaster Care, Denver Health-University of Colorado

Joshua B Gaither, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Carin M Van Gelder, MD  Assistant Professor, Department of Emergency Medicine, Yale University; EMS Medical Director, NHSHP and EMS Physician, SHARP Team; Attending Physician, Emergency Medicine, Yale-New Haven Medical Center

Carin M Van Gelder, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Massachusetts Medical Society, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT  Associate Clinical Professor, Department of Surgery/Emergency Medicine and Toxicology, University of Texas School of Medicine at San Antonio; Medical and Managing Director, South Texas Poison Center

Miguel C Fernandez, MD, FAAEM, FACEP, FACMT, FACCT is a member of the following medical societies: American Academy of Emergency Medicine, American College of Clinical Toxicologists, American College of Emergency Physicians, American College of Medical Toxicology, American College of Occupational and Environmental Medicine, Society for Academic Emergency Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Eileen C Quintana, MD, and Richard Sinert, DO, to the development and writing of this article.

References

  1. Bronstein AC, Spyker DA, Cantilena LR Jr, et al. 2009 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol (Phila). Dec 2010;48(10):979-1178. [Medline].

  2. Tzivoni D, Banai S, Schuger C, Benhorin J, Keren A, Gottlieb S, et al. Treatment of torsade de pointes with magnesium sulfate. Circulation. Feb 1988;77(2):392-7. [Medline].

  3. ATMAI. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials. Amiodarone Trials Meta-Analysis Investigators. Lancet. Nov 15 1997;350(9089):1417-24. [Medline].

  4. Bacaner M, Brietenbucher J, LaBree J. Prevention of ventricular fibrillation, acute myocardial infarction (myocardial necrosis), heart failure, and mortality by bretylium: is ischemic heart disease primarily adrenergic cardiovascular disease?. Am J Ther. Sep-Oct 2004;11(5):366-411. [Medline].

  5. Batcher EL, Tang XC, Singh BN, Singh SN, Reda DJ, Hershman JM. Thyroid function abnormalities during amiodarone therapy for persistent atrial fibrillation. Am J Med. Oct 2007;120(10):880-5. [Medline].

  6. Connolly SJ, Schnell DJ, Page RL, et al. Dose-response relations of azimilide in the management of symptomatic, recurrent, atrial fibrillation. Am J Cardiol. Nov 1 2001;88(9):974-9. [Medline].

  7. Ellenhorn MJ, ed. Antidysrhythmic agents toxicity. In: Ellenhorn's Medical Toxicology - Diagnosis and Treatment of Human Poisoning. 2nd ed. Lippincott Williams & Wilkins; 1997:498-551.

  8. Goldfrank L. Antidysrhythmic agent toxicity. In: Goldfrank's Toxicology Emergencies. McGraw-Hill;1994:715-25.

  9. Hoffman BF. Arrhythmias and antiarrhythmic drugs. Mt Sinai J Med. Mar 1997;64(2):136-41. [Medline].

  10. Hohnloser SH. Proarrhythmia with class III antiarrhythmic drugs: types, risks, and management. Am J Cardiol. Oct 23 1997;80(8A):82G-89G. [Medline].

  11. Joshi S, Raiszadeh F, Pierce W, Steinberg JS. Antiarrhythmic induced electrical storm in Brugada syndrome: a case report. Ann Noninvasive Electrocardiol. Jul 2007;12(3):274-8. [Medline].

  12. Juurlink DN, Mamdani M, Kopp A, et al. Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA. Apr 2 2003;289(13):1652-8. [Medline].

  13. Kowey PR, Marinchak RA, Rials SJ, Bharucha D. Pharmacologic and pharmacokinetic profile of class III antiarrhythmic drugs. Am J Cardiol. Oct 23 1997;80(8A):16G-23G. [Medline].

  14. MacNeil DJ. The side effect profile of class III antiarrhythmic drugs: focus on d,l- sotalol. Am J Cardiol. Oct 23 1997;80(8A):90G-98G. [Medline].

  15. Naccarelli GV, Wolbrette DL, Khan M, et al. Old and new antiarrhythmic drugs for converting and maintaining sinus rhythm in atrial fibrillation: comparative efficacy and results of trials. Am J Cardiol. Mar 20 2003;91(6A):15D-26D. [Medline].

  16. Ravishankar R, Samuels LE, Kaufman MS, et al. Amiodarone-associated hemoptysis. Am J Med Sci. Dec 1998;316(6):390-2. [Medline].

  17. Wyman MG, Wyman RM, Cannom DS, Criley JM. Prevention of primary ventricular fibrillation in acute myocardial infarction with prophylactic lidocaine. Am J Cardiol. Sep 1 2004;94(5):545-51. [Medline].

  18. Saksena S, Slee A, Waldo AL, Freemantle N, Reynolds M, Rosenberg Y, et al. Cardiovascular Outcomes in the AFFIRM Trial (Atrial Fibrillation Follow-Up Investigation of Rhythm Management) An Assessment of Individual Antiarrhythmic Drug Therapies Compared With Rate Control With Propensity Score-Matched Analyses. J Am Coll Cardiol. Nov 1 2011;58(19):1975-85. [Medline].

  19. Nattel S. Dronedarone in Atrial Fibrillation - Jekyll and Hyde?. N Engl J Med. Nov 14 2011;[Medline].

  20. Kozlowski D, Budrejko S, Lip GY, Mikhailidis DP, Rysz J, Raczak G, et al. Dronedarone: An overview. Ann Med. Jul 11 2011;[Medline].

  21. Jackevicius CA, Tom A, Essebag V, Eisenberg MJ, Rahme E, Tu JV, et al. Population-level incidence and risk factors for pulmonary toxicity associated with amiodarone. Am J Cardiol. Sep 1 2011;108(5):705-10. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.