A 48-year-old woman developed QT prolongation and episodes of life-threatening ventricular tachycardia (torsades de pointes) after intentional overdose of haloperidol and orphenadrine. The arrhythmia did not respond to conventional anti-arrhythmic therapy but was suppressed by atrial overdrive pacing. A literature review identified haloperidol as the most likely cause of the torsades de pointes.
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References
1.
Krikler DM & Curry Pvl.Torsades de pointes, an atypical ventricular tachycardia. British Heart Journal1976; 38: 117-20.
2.
Kay GN, Plumb VJ, Arciniegas JG, Henthorn RW & Waldo ALTorsades de pointes: the long-short initiating sequence and other clinical features: observation in 32 patients. Journal ofthe American College of Cardiology1983; 2: 806-17.
3.
Tzivoni D., Keren A. & Stern S.Torsades de pointes versus polymorphous ventricular tachycardia. American Journal of Cardiology1983; 52: 639-40.
4.
Zee-Cheng CS , Mueller CE, Seifert CF & Gibbs HRHaloperidol and torsades de pointes. Annals of Internal Medicine1985; 102: 418.
5.
Fayer SATorsades de pointes ventricular tachyarrhythmia associated with haloperidol . Journal of Clinical Psychopharmacology1986 ; 6: 375-6.
6.
Mehta D., Mehta S., Petit J. & Shriner W.Cardiac arrhythmia and haloperidol. American Journal of Psychiatry1979; 136: 1468.
7.
Bett Jhn & Holt GWMalignant ventricular tachycardia and haloperidol. British Medical Journal1983; 287: 1264.
8.
Snyder BD, Kane M. & Plocher D.Orphenadrine overdose treated with physostigmine. New England Journal of Medicine1976; 295: 1435.
9.
Bennett MB & Kohn J.Case report: orphenadrine overdose. Cerebral manifestation treated with physostigmine . Anaesthesia and Intensive Care1976; 4:67.
10.
Sangster B. , Van Heijst Anp, Zimmerman Ane & De Vries HWIntoxication by orphenadrine HCl; mechanism and therapy. Acta Phamacologica et Toxicologica1977; 41 (suppl 2): 129-36.
11.
Bozza-Marrubini M., Frigerio A., Ghezzi R. et al. Two cases of severe orphenadrine poisoning with atypical features. Acta Pharmacologica et Toxicologica1977; 41 (suppl 2): 137-52.
12.
Heinonen J. , Heikkila J., Mattila MJ & Takki S.Orphenadrine poisoning. A case supplemented with animal experiments. Archiv für Toxikologie1968; 23: 264-72.
13.
Stoddart JC , Parkin JM & Wynne NAOrphenadrine poisoning . British Journal of Anaesthesia1968; 40: 789-90.
14.
Millar WMDeaths after overdoses of orphenadrine. Lancet1977; ii: 566.
15.
Clarke B., Mair J. & Rudolf M.Acute poisoning with orphenadrine. Lancet1985; i: 1386.
16.
Doenecke Al & Heuermann RCTreatment of haloperidol abuse with diphenhydramine . American Journal of Psychiatry1980; 137: 487-8.