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Prolonged Quinidine Half‐life with Associated Toxicity in a Patient with Hepatic Failure
Author(s) -
Stanek Eric J.,
Simko Robert J.,
DeNofrio David,
Pavri Behzad B.
Publication year - 1997
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/j.1875-9114.1997.tb03075.x
Subject(s) - quinidine , toxicity , medicine , torsades de pointes , pharmacokinetics , qt interval , hepatic dysfunction , drug interaction , pharmacology , anesthesia
A markedly prolonged quinidine elimination half‐life due to hepatic failure and resultant quinidine toxicity occurred in a 57‐year‐old man with a history of atrial fibrillation. A prolonged QT interval, development of torsades de pointes, and a serum quinidine concentration of 3.1 μg/ml contributed to a decision favoring permanent pacemaker implantation. The apparent quinidine half‐life ranged from 66–99 hours and was associated with QT prolongation and persistent U waves. On discontinuing quinidine, all signs associated with toxicity resolved as serum quinidine concentrations decreased, which resulted in reversal of the decision to implant a permanent pacemaker. This case reports an extremely long quinidine elimination half‐life and reillustrates the importance of drug pharmacokinetics in patient care.