Tunney R K, Whyte K, DeAntonio H J
East Carolina Heart Institute at ECU, Greenville, NC, USA.
Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA.
J Clin Pharm Ther. 2018 Oct;43(5):733-736. doi: 10.1111/jcpt.12717. Epub 2018 Jun 9.
Lidocaine infused at 1-4 mg/min is an appropriate treatment modality for hemodynamically stable ventricular tachycardia (VT) with normal hepatic function. A case of acute lidocaine toxicity in the setting of left ventricular assist device (LVAD) is reported.
A 71-year-old with a HeartMate II LVAD on chronic mexiletine and normal liver function presented with ventricular tachycardia requiring systemic lidocaine and subsequently developed altered mental status with tremors. A lidocaine level obtained within 24 hours of infusion initiation was 7.9 mcg/mL.
This case highlights the potential for marked deviation from published pharmacokinetic parameters for a narrow therapeutic window agent with concurrent LVAD.
对于肝功能正常、血流动力学稳定的室性心动过速（VT）患者，以1 - 4毫克/分钟的速度输注利多卡因是一种合适的治疗方式。本文报告了一例在左心室辅助装置（LVAD）情况下发生急性利多卡因中毒的病例。
一名71岁患者，植入HeartMate II型LVAD，长期服用美西律且肝功能正常，出现室性心动过速，需要全身性使用利多卡因，随后出现精神状态改变并伴有震颤。在开始输注后24小时内测得的利多卡因水平为7.9微克/毫升。
该病例突出了在同时使用LVAD的情况下，窄治疗窗药物的药代动力学参数可能会与已发表的参数有显著偏差。
