Zareba W, Moss A J, Rosero S Z, Hajj-Ali R, Konecki J, Andrews M
University of Rochester Medical Center, New York 14642, USA.
Am J Cardiol. 1997 Nov 1;80(9):1168-73. doi: 10.1016/s0002-9149(97)00634-6.
QT interval prolongation and torsades de pointes ventricular tachycardia have been reported after therapeutic doses and overdosage of second generation antihistamines, such terfenadine and astemizol. Diphenhydramine (DPHM), a first generation H1 antagonist, is the most frequently used antihistaminic drug. Despite its widespread use, there are no data about cardiac action and electrocardiographic consequences of DPHM overdose. The 12-lead electrocardiograms of 126 patients (mean age 26 +/- 11 years) who had DPHM overdose were evaluated. The ingestion of large doses of DPHM (in majority of cases the dose was >500 mg) was primarily suicidal. Repolarization duration, dispersion, and morphology were evaluated in DPHM overdose patients and compared with those of healthy subjects. Mean heart rate of DPHM overdose patients was 103 +/- 25 beats/min. The QTc duration was significantly longer (453 +/- 43 vs 416 +/- 35 ms, respectively, p <0.001) and mean T-wave amplitude significantly lower (0.20 +/- 0.10 vs 0.33 +/- 0.15 mV, respectively, p <0.001) in DPHM-overdose patients than in control subjects. Dispersion of repolarization was significantly lower in DPHM-overdose patients than in control subjects (42 +/- 25 vs 52 +/- 21 ms, respectively; p = 0.003). None of the DPHM-overdose patients experienced torsades de pointes. In conclusion, DPHM overdose is associated with a significant increase in heart rate and a significant but moderate QTc prolongation. None of the studied patients, including those who had apparent QTc prolongation, experienced torsades de pointes ventricular tachycardia.
据报道，第二代抗组胺药（如特非那定和阿司咪唑）在治疗剂量和过量服用后可导致QT间期延长和尖端扭转型室性心动过速。第一代H1拮抗剂苯海拉明（DPHM）是最常用的抗组胺药物。尽管其使用广泛，但关于DPHM过量服用对心脏的作用及心电图影响的数据却未见报道。我们对126例过量服用DPHM的患者（平均年龄26±11岁）的12导联心电图进行了评估。大量服用DPHM（大多数病例剂量>500mg）主要是出于自杀目的。对DPHM过量服用患者的复极持续时间、离散度和形态进行了评估，并与健康受试者进行了比较。DPHM过量服用患者的平均心率为103±25次/分钟。DPHM过量服用患者的QTc间期明显更长（分别为453±43 vs 416±35毫秒，p<0.001），平均T波振幅明显更低（分别为0.20±0.10 vs 0.33±0.15毫伏，p<0.001）。DPHM过量服用患者的复极离散度明显低于对照组（分别为42±25 vs 52±21毫秒；p = 0.003）。所有DPHM过量服用患者均未发生尖端扭转型室性心动过速。总之，DPHM过量服用与心率显著增加以及QTc明显但中度延长有关。包括那些QTc明显延长的患者在内，所有研究患者均未发生尖端扭转型室性心动过速。
