Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Auburn University, 1321 Walker Building, Auburn, AL 36849-5501, USA.
Cardiovasc Toxicol. 2010 Dec;10(4):306-10. doi: 10.1007/s12012-010-9088-5.
We report a case of potential cardiovascular toxicity including syncope, bradycardia, and ECG pauses associated with the use of rivastigmine and atenolol. A 65-year-old African American female with a medical history of dementia, hypertension, seizure disorder, stroke, and peripheral vascular disease was admitted to the hospital with shortness of breath and syncope. She was witnessed to have experienced a presyncopal episode followed by a true syncopal episode in which she was unresponsive for 20-30 s. On day two of hospital stay, the patient's ECG showed a sinus bradycardia with a heart rate in the 40 s and sinus pauses greater than 2 s in duration. Atenolol was immediately discontinued, with a continuance of the bradycardia despite one missed dose. The potentially toxic combination of rivastigmine and atenolol was then identified as a plausible causative factor of this patient's syncope and was subsequently discontinued. This patient's Naranjo adverse reaction probability score was five, which indicates a probable association between syncope and bradycardia with the combination of rivastigmine and atenolol [13]. Following the discontinuation of rivastigmine, the ECG pauses resolved and the patient's heart rate returned to normal levels. The patient did not experience any further dizziness or syncope. A 65-year-old female developed syncope and subsequent ECG pauses with sinus bradycardia after being treated with rivastigmine for dementia. Atenolol may have further compounded this toxic effect by its pharmacodynamic mechanisms.
我们报告了一例潜在的心血管毒性病例，包括与利斯的明和阿替洛尔使用相关的晕厥、心动过缓和心电图暂停。一名 65 岁的非裔美国女性，有痴呆、高血压、癫痫、中风和外周血管疾病病史，因呼吸急促和晕厥入院。她被目击经历了一次先兆晕厥，随后是一次真正的晕厥，持续 20-30 秒失去反应。在住院的第二天，患者的心电图显示窦性心动过缓，心率在 40 次/分，窦性暂停超过 2 秒。立即停用阿替洛尔，尽管漏用了一次剂量，但仍持续出现心动过缓。随后确定利斯的明和阿替洛尔的潜在毒性组合是导致该患者晕厥的合理原因，并随后停用。该患者的 Naranjo 不良反应概率评分为 5，表明晕厥和心动过缓与利斯的明和阿替洛尔的组合之间存在可能的关联[13]。停用利斯的明后，心电图暂停消失，患者的心率恢复正常水平。患者未再出现头晕或晕厥。一名 65 岁女性在接受利斯的明治疗痴呆后出现晕厥和随后的窦性心动过缓心电图暂停。阿替洛尔可能通过其药效学机制进一步加重了这种毒性作用。
