Ventricular bigeminy associated with voriconazole, methadone and esomeprazole.
Summary of "Ventricular bigeminy associated with voriconazole, methadone and esomeprazole."
Case We report a case of ventricular bigeminy with concomitant administration of methadone, voriconazole and esomeprazole in a Caucasian woman aged 26 with acute lymphoblastic leukaemia. Plasma concentrations of voriconazole and methadone were high, 12.4 mg/l (therapeutic range: 1-4 mg/l) and 1.6 mg/l (therapeutic range: 0.2-0.4 mg/l), respectively. In the absence of esomeprazole, no more episode of cardiac arrhythmia occurred and 7 days after, methadone plasma concentration fell at 0.57 ml/l while voriconazole concentration was at 5.5 mg/l. We speculate that a pharmacokinetic interaction between methadone and voriconazole was amplified by the addition of esomeprazole. This led to the large increase of the plasma concentration of methadone and was potentially responsible for its cardiac toxicity. Conclusion Physicians should be aware of the potential interaction between voriconazole, esomeprazole and methadone leading to arrhythmia. The inhibitory potential of voriconazole is possibly increased by esomeprazole.
Pharmacy, Hôpital Hautepierre, Hôpitaux Universitaires de Strasbourg, Avenue Molière, 67000, Strasbourg, France.
This article was published in the following journal.
Name: International journal of clinical pharmacy
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22108788
- DOI: http://dx.doi.org/10.1007/s11096-011-9581-3
Medical and Biotech [MESH] Definitions
A synthetic opioid that is used as the hydrochloride. It is an opioid analgesic that is primarily a mu-opioid agonist. It has actions and uses similar to those of MORPHINE. It also has a depressant action on the cough center and may be given to control intractable cough associated with terminal lung cancer. Methadone is also used as part of the treatment of dependence on opioid drugs, although prolonged use of methadone itself may result in dependence. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1082-3)
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