Case Report of Ivabradine Intoxication
Ivabradine is a drug used for the treatment of angina and chronic heart failure in cases of intolerance or insufficiency of response to beta-blocker treatment. A 47-year-old man was admitted to the emergency department of the hospital for a voluntary intoxication with 280 mg of ivabradine: he presen...
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Published in | Journal of analytical toxicology Vol. 38; no. 4; pp. 231 - 232 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
England
Oxford University Press
01.05.2014
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Abstract | Ivabradine is a drug used for the treatment of angina and chronic heart failure in cases of intolerance or insufficiency of response to beta-blocker treatment. A 47-year-old man was admitted to the emergency department of the hospital for a voluntary intoxication with 280 mg of ivabradine: he presented drowsiness and a mild sinusal bradycardia (50 bpm) associated with a well-tolerated low blood pressure at 100/50 mmHg. No complication was noted and he was discharged from the hospital on Day 3. A method for ivabradine assay in serum was obtained using liquid chromatography coupled with a mass spectrometry detection method. After a deproteinization step using QuECHERS salts and acetonitrile, a chromatographic separation was performed using a 5-µm 50 × 2.1 mm Xterra® column (Waters, France). Detection was performed using an LTQ linear ion-trap mass spectrometer equipped with an electrospray ionization source used in a positive ionization mode (ThermoFisher Scientific, San Jose CA, USA) and a detection in full MS2 scan. The limit of quantification of ivabradine was 10 µg/L, and the method was linear up to 1000 µg/L. The ivabradine concentration in the patient's serum was 375 µg/L. This concentration value was >30 times those measured after therapeutic doses intakes. Nevertheless, the bradycardia was no more severe than the one observed with therapeutic dosage. In conclusion, this case tends to show an absence of correlation between blood concentration and severity of the troubles in cases of overdosage. |
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AbstractList | Ivabradine is a drug used for the treatment of angina and chronic heart failure in cases of intolerance or insufficiency of response to beta-blocker treatment. A 47-year-old man was admitted to the emergency department of the hospital for a voluntary intoxication with 280 mg of ivabradine: he presented drowsiness and a mild sinusal bradycardia (50 bpm) associated with a well-tolerated low blood pressure at 100/50 mmHg. No complication was noted and he was discharged from the hospital on Day 3. A method for ivabradine assay in serum was obtained using liquid chromatography coupled with a mass spectrometry detection method. After a deproteinization step using QuECHERS salts and acetonitrile, a chromatographic separation was performed using a 5-µm 50 × 2.1 mm Xterra® column (Waters, France). Detection was performed using an LTQ linear ion-trap mass spectrometer equipped with an electrospray ionization source used in a positive ionization mode (ThermoFisher Scientific, San Jose CA, USA) and a detection in full MS2 scan. The limit of quantification of ivabradine was 10 µg/L, and the method was linear up to 1000 µg/L. The ivabradine concentration in the patient's serum was 375 µg/L. This concentration value was >30 times those measured after therapeutic doses intakes. Nevertheless, the bradycardia was no more severe than the one observed with therapeutic dosage. In conclusion, this case tends to show an absence of correlation between blood concentration and severity of the troubles in cases of overdosage. Ivabradine is a drug used for the treatment of angina and chronic heart failure in cases of intolerance or insufficiency of response to beta-blocker treatment. A 47-year-old man was admitted to the emergency department of the hospital for a voluntary intoxication with 280 mg of ivabradine: he presented drowsiness and a mild sinusal bradycardia (50 bpm) associated with a well-tolerated low blood pressure at 100/50 mmHg. No complication was noted and he was discharged from the hospital on Day 3. A method for ivabradine assay in serum was obtained using liquid chromatography coupled with a mass spectrometry detection method. After a deproteinization step using QuECHERS salts and acetonitrile, a chromatographic separation was performed using a 5-µm 50 × 2.1 mm Xterra® column (Waters, France). Detection was performed using an LTQ linear ion-trap mass spectrometer equipped with an electrospray ionization source used in a positive ionization mode (ThermoFisher Scientific, San Jose CA, USA) and a detection in full MS(2) scan. The limit of quantification of ivabradine was 10 µg/L, and the method was linear up to 1000 µg/L. The ivabradine concentration in the patient's serum was 375 µg/L. This concentration value was >30 times those measured after therapeutic doses intakes. Nevertheless, the bradycardia was no more severe than the one observed with therapeutic dosage. In conclusion, this case tends to show an absence of correlation between blood concentration and severity of the troubles in cases of overdosage. |
Author | Mathiaux, François Dulaurent, Sylvain Julia, Frédéric Gaulier, Jean-Michel |
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CitedBy_id | crossref_primary_10_1016_j_forsciint_2020_110288 crossref_primary_10_1016_j_medin_2015_04_008 crossref_primary_10_1007_s13181_016_0537_9 crossref_primary_10_1007_s40278_014_0667_2 crossref_primary_10_2131_fts_10_315 crossref_primary_10_1177_1074248415624157 crossref_primary_10_1186_s13256_022_03554_w crossref_primary_10_1016_j_toxac_2019_03_048 crossref_primary_10_2131_jts_47_99 crossref_primary_10_1016_j_hrcr_2019_12_007 crossref_primary_10_1007_s11419_021_00570_1 crossref_primary_10_1080_14740338_2019_1612873 crossref_primary_10_1310_hpj5009_806 |
Cites_doi | 10.1016/j.chroma.2010.01.044 10.1016/j.forsciint.2006.05.021 10.1007/s12325-010-0014-9 10.1016/j.jchromb.2013.01.016 10.1007/s40265-013-0117-0 10.1016/j.aca.2004.08.055 |
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Copyright | The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com 2014 |
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SubjectTerms | Anti-Arrhythmia Agents - administration & dosage Anti-Arrhythmia Agents - blood Anti-Arrhythmia Agents - toxicity Benzazepines - administration & dosage Benzazepines - blood Benzazepines - toxicity Bradycardia - blood Bradycardia - chemically induced Drug Overdose Humans Hypotension - blood Hypotension - chemically induced Male Middle Aged Severity of Illness Index Spectrometry, Mass, Electrospray Ionization |
Title | Case Report of Ivabradine Intoxication |
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