ABSTRACT
Ivabradine is a newly approved medication which reduces the heart rate by antagonizing the If channel. We report a case of intentional overdose on ivabradine. A 26-year-old female presented after taking 250 mg ivabradine. On arrival, her vital signs and neurologic exam were unremarkable. Within 30 min, her heart rate decreased to 31 bpm, but she remained normotensive with no change in mentation. Her bradycardia resolved after treatment with atropine. She experienced two further bradycardic episodes responsive to atropine; the second episode was associated with hypotension, responsive to a fluid bolus. For the remainder of her hospitalization, she remained hemodynamically stable without further interventions. She was dispositioned to the psychiatry service approximately 36 h post-ingestion with a heart rate of 67 bpm. Laboratory analysis confirmed a serum ivabradine concentration of 525 ng/mL, greater than 50 times the mean level in therapeutic trials. Proposed treatments for ivabradine include activated charcoal, atropine, isoproterenol, and intravenous pacing. Further study is needed to identify ideal treatment modalities.
Subject(s)
Anti-Arrhythmia Agents/poisoning , Benzazepines/poisoning , Cyclic Nucleotide-Gated Cation Channels/antagonists & inhibitors , Drug Overdose/physiopathology , Membrane Transport Modulators/poisoning , Adult , Anti-Arrhythmia Agents/blood , Anti-Arrhythmia Agents/therapeutic use , Atropine/therapeutic use , Benzazepines/blood , Benzazepines/therapeutic use , Bradycardia/etiology , Bradycardia/prevention & control , Combined Modality Therapy , Cyclic Nucleotide-Gated Cation Channels/metabolism , Drug Overdose/drug therapy , Drug Overdose/metabolism , Drug Overdose/therapy , Emergency Service, Hospital , Female , Humans , Ivabradine , Membrane Transport Modulators/blood , Membrane Transport Modulators/therapeutic use , Postural Orthostatic Tachycardia Syndrome/drug therapy , Suicide, Attempted , Treatment Outcome , VirginiaABSTRACT
OBJECTIVE: The purpose of this study was to determine whether 400 µg/kg oral ivermectin is able to kill Ixodes scapularis nymphs and adult female ticks feeding on humans. METHODS: Ten study subjects each wore 2 ostomy bags, the one containing 24 I scapularis nymphs, and the other containing 24 I scapularis adult females. Twenty-four hours after the ostomy bags were attached, study subjects received either 400 µg/kg ivermectin or placebo. Thirty hours after the ivermectin or placebo was consumed, the ticks were removed, and mortality determined in a double-blinded manner. RESULTS: Eleven percent of the I scapularis nymphs attached in the ivermectin group compared with 17% in the placebo. Mortality for the I scapularis nymphs that attached at the time of removal was 55% in the ivermectin group and 47% in the placebo group. Mortality for the I scapularis nymphs 5 days after removal was 92% in the ivermectin group and 88% for the placebo. Three percent of the I scapularis adults attached in the ivermectin group compared with 9% in the placebo group. Mortality for I scapularis adults was 0% on day 3 and 33% on day 8 for both the ivermectin and placebo groups. There were statistically insignificant differences in the mortality rates between I scapularis nymphs and adults exposed to ivermectin or placebo. CONCLUSIONS: There were a high number of ticks that died in both groups but the data do not support our hypothesis that ivermectin can kill I scapularis. The study was not designed to determine whether it could prevent the transmission of tick-borne illness.
