Cortes Jennifer, Hall Brad, Redden Danyelle
Lakeland Regional Medical Center, Lakeland, Florida.
J Emerg Med. 2015 Apr;48(4):458-60. doi: 10.1016/j.jemermed.2014.10.005. Epub 2014 Nov 20.
We report a case of profound symptomatic bradycardia after a single dose of tizanidine.
A 93-year-old female became altered and was found to have hypotension and profound symptomatic bradycardia 30 min post ingestion of a single 4-mg dose of tizanidine at her physician's office. Emergency Medical Services was called to scene and patient was transported to our tertiary medical center. In the emergency department, the patient required intubation, vasopressor support, and transcutaneous pacing. An electrocardiogram revealed atrial fibrillation with slow ventricular response with a heart rate of 19 beats/min. The patient was transferred to the intensive care unit and subsequently taken for cardiac catheterization, where a transvenous pacer was placed. During the next few days, her vital signs and mental status improved, allowing for successful extubation. Before discharge, the patient received a single-chamber pacemaker.
Profound symptomatic bradycardia from a single dose of tizanidine has not been reported. A review of the patient's medications did not reveal a significant cytochrome P450 drug interaction to result in an adverse effect as previously reported in the literature.
Tizanidine should be used cautiously in elderly population and drug interactions screening should be performed.
我们报告一例单次服用替扎尼定后出现严重症状性心动过缓的病例。
一名93岁女性在其医生办公室单次服用4毫克替扎尼定30分钟后出现意识改变，发现有低血压和严重症状性心动过缓。紧急医疗服务人员被呼叫到现场，患者被转运至我们的三级医疗中心。在急诊科，患者需要插管、血管加压药支持和经皮起搏。心电图显示心房颤动伴缓慢心室反应，心率为19次/分钟。患者被转至重症监护病房，随后接受心脏导管插入术，并置入了经静脉起搏器。在接下来的几天里，她的生命体征和精神状态有所改善，得以成功拔管。出院前，患者接受了单腔起搏器。
单次服用替扎尼定导致严重症状性心动过缓的情况此前未见报道。对患者的药物进行审查未发现如文献中先前报道的会导致不良反应的显著细胞色素P450药物相互作用。
替扎尼定在老年人群中应谨慎使用，并应进行药物相互作用筛查。
