CLINICAL COURSE OF A DEATH FROM RANOLAZINE OVERDOSE: A CASE REPORT

Year 2020, Volume: 11 Issue: 2, 35 - 38, 09.10.2020

Mehmet Ali Yavuz Ramazan Asoglu

https://doi.org/10.33706/jemcr.607486

Cited By: 2

Abstract

Introduction: Ranolazine is a new medication for angina
pectoris. It is usually used for refractory angina pectoris. Ranolazine
overdose may cause some serious effects on heart like other cardiac medications.

Case Report: We report the case of a 21-year-old girl
was brought to the emergency department because of an attempt to commit suicide
with a large number of Ranolazine tablets. She went into the coma and was
unresponsive to verbal and painful stimuli after two hours of admission. There
was no pathological findings on brain computed tomography (CT) and Magnetic
Resonance Imaging (MRI). The QT interval was 420 msec and more extended than
previous measurements. The patient had three episodes of polymorphic
nonsustained ventricular tachycardia (NSVT). Despite the amiodarone treatment,
the NSVT evolved to polymorphic sustained ventricular tachycardia (Torsade de
Pointes; TdP) and Ventricular fibrillation (VF). The patient underwent CPR and
accepted as death end of the resuscitation due to asystole on the ECG.

Conclusion: Ranolazine overdose is known that may cause
some serious ECG changes and seizures. But suddenly entering a coma and death
has never been reported with ranolazine intoxication in literature.

Keywords

Ranolazine overdose, Death, Torsades De Pointes

References

• Reference1. Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J, Pepine CJ, Wang W, Nelson JJ, Hebert DA, Wolff AA. Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. Journal of the American College of Cardiology 2004 Apr 21;43(8):1375-82.
• Referene2. Akil N, Bottei E, Kamath S. Ranolazine overdose–induced seizures. The American journal of emergency medicine 2015 Dec 1;33(12):1843-5.
• Referene3. Sossalla S, Wagner S, Rasenack EC, Ruff H, Weber SL, Schöndube FA, Tirilomis T, Tenderich G, Hasenfuss G, Belardinelli L, Maier LS. Ranolazine improves diastolic dysfunction in isolated myocardium from failing human hearts—role of late sodium current and intracellular ion accumulation. Journal of molecular and cellular cardiology 2008 Jul 1;45(1):32-43.
• Referene4. Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J, Wang W, Skettino SL, Wolff AA, Combination Assessment of Ranolazine In Stable Angina (CARISA) Investigators. Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. Jama 2004 Jan 21;291(3):309-16.
• Referene5. Abdallah H, Jerling M. Effect of hepatic impairment on the multiple‐dose pharmacokinetics of ranolazine sustained‐release tablets. The Journal of Clinical Pharmacology 2005 Jul 1;45(7):802-9.
• Referene6. Stone PH, Gratsiansky NA, Blokhin A, Huang IZ, Meng L, ERICA Investigators. Antianginal efficacy of ranolazine when added to treatment with amlodipine: the ERICA (Efficacy of Ranolazine in Chronic Angina) trial. Journal of the American College of Cardiology 2006 Aug 1;48(3):566-75.
• Referene7. Kalra SS, Arora Z, Nielsen C. Ranolazine and Hallucinations. Journal of Medical Cases 2017 Mar 5;8(3):90-2.
• Referene8. Morrow DA, Scirica BM, Karwatowska-Prokopczuk E, Murphy SA, Budaj A, Varshavsky S, Wolff AA, Skene A, McCabe CH, Braunwald E, MERLIN-TIMI 36 Trial Investigators. Effects of ranolazine on recurrent cardiovascular events in patients with non–ST-elevation acute coronary syndromes: the MERLIN-TIMI 36 randomized trial. Jama 2007 Apr 25;297(16):1775-83.
• Referene9. Chaitman BR. Efficacy and safety of a metabolic modulator drug in chronic stable angina: review of evidence from clinical trials. Journal of cardiovascular pharmacology and therapeutics 2004 Mar;9(1_suppl): S47-64.