{"title":"QT间期延长与治疗浓度过高的关法辛有关：病例报告。","authors":"Fumiya Inoue, Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba, Akira Namera","doi":"10.1007/s13181-023-00986-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Guanfacine, an alpha-2 adrenergic agonist, is used to treat attention deficit hyperactivity disorder (ADHD). Although cardiovascular effects including hypotension and bradycardia are common adverse effects of guanfacine, the effect of guanfacine on QT intervals remains unclear. The association between the serum concentration of guanfacine and its toxicity has also not been fully investigated.</p><p><strong>Case report: </strong>This is a case of a 21-year-old woman with ADHD who developed repeated presyncope 1 day before admission. She was taking 3 mg of extended-release guanfacine and 50 mg of sertraline. On admission, she had bradycardia and hypotension. An electrocardiogram (ECG) showed a QT interval of 0.68 s and a QTcF interval of 0.648 s. The QT intervals were manually measured and corrected by the Fridericia formula (QTcF = QT/RR<sup>1/3</sup>). Although she denied taking an overdose of guanfacine and other drugs, we suspected guanfacine toxicity. The serum guanfacine concentration was 13.0 ng/mL on admission and decreased to 3.2 ng/mL on day 1 and 0.4 ng/mL on day 2. Changes in QTcF intervals and her vital signs correlated with serum guanfacine concentrations.</p><p><strong>Conclusion: </strong>Supratherapeutic serum guanfacine concentrations may induce QT prolongation.</p>","PeriodicalId":16429,"journal":{"name":"Journal of Medical Toxicology","volume":null,"pages":null},"PeriodicalIF":2.5000,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959869/pdf/","citationCount":"0","resultStr":"{\"title\":\"QT-Interval Prolongation Associated with Supratherapeutic Guanfacine Concentration: A Case Report.\",\"authors\":\"Fumiya Inoue, Yuji Okazaki, Kenichiro Kashiwa, Toshihisa Ichiba, Akira Namera\",\"doi\":\"10.1007/s13181-023-00986-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Guanfacine, an alpha-2 adrenergic agonist, is used to treat attention deficit hyperactivity disorder (ADHD). Although cardiovascular effects including hypotension and bradycardia are common adverse effects of guanfacine, the effect of guanfacine on QT intervals remains unclear. The association between the serum concentration of guanfacine and its toxicity has also not been fully investigated.</p><p><strong>Case report: </strong>This is a case of a 21-year-old woman with ADHD who developed repeated presyncope 1 day before admission. She was taking 3 mg of extended-release guanfacine and 50 mg of sertraline. On admission, she had bradycardia and hypotension. An electrocardiogram (ECG) showed a QT interval of 0.68 s and a QTcF interval of 0.648 s. The QT intervals were manually measured and corrected by the Fridericia formula (QTcF = QT/RR<sup>1/3</sup>). Although she denied taking an overdose of guanfacine and other drugs, we suspected guanfacine toxicity. The serum guanfacine concentration was 13.0 ng/mL on admission and decreased to 3.2 ng/mL on day 1 and 0.4 ng/mL on day 2. Changes in QTcF intervals and her vital signs correlated with serum guanfacine concentrations.</p><p><strong>Conclusion: </strong>Supratherapeutic serum guanfacine concentrations may induce QT prolongation.</p>\",\"PeriodicalId\":16429,\"journal\":{\"name\":\"Journal of Medical Toxicology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959869/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Medical Toxicology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s13181-023-00986-8\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"TOXICOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Toxicology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13181-023-00986-8","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"TOXICOLOGY","Score":null,"Total":0}
QT-Interval Prolongation Associated with Supratherapeutic Guanfacine Concentration: A Case Report.
Introduction: Guanfacine, an alpha-2 adrenergic agonist, is used to treat attention deficit hyperactivity disorder (ADHD). Although cardiovascular effects including hypotension and bradycardia are common adverse effects of guanfacine, the effect of guanfacine on QT intervals remains unclear. The association between the serum concentration of guanfacine and its toxicity has also not been fully investigated.
Case report: This is a case of a 21-year-old woman with ADHD who developed repeated presyncope 1 day before admission. She was taking 3 mg of extended-release guanfacine and 50 mg of sertraline. On admission, she had bradycardia and hypotension. An electrocardiogram (ECG) showed a QT interval of 0.68 s and a QTcF interval of 0.648 s. The QT intervals were manually measured and corrected by the Fridericia formula (QTcF = QT/RR1/3). Although she denied taking an overdose of guanfacine and other drugs, we suspected guanfacine toxicity. The serum guanfacine concentration was 13.0 ng/mL on admission and decreased to 3.2 ng/mL on day 1 and 0.4 ng/mL on day 2. Changes in QTcF intervals and her vital signs correlated with serum guanfacine concentrations.
Conclusion: Supratherapeutic serum guanfacine concentrations may induce QT prolongation.
期刊介绍：
Journal of Medical Toxicology (JMT) is a peer-reviewed medical journal dedicated to advances in clinical toxicology, focusing on the diagnosis, management, and prevention of poisoning and other adverse health effects resulting from medications, chemicals, occupational and environmental substances, and biological hazards. As the official journal of the American College of Medical Toxicology (ACMT), JMT is managed by an editorial board of clinicians as well as scientists and thus publishes research that is relevant to medical toxicologists, emergency physicians, critical care specialists, pediatricians, pre-hospital providers, occupational physicians, substance abuse experts, veterinary toxicologists, and policy makers. JMT articles generate considerable interest in the lay media, with 2016 JMT articles cited by various social media sites, the Boston Globe, and the Washington Post among others. For questions or comments about the journal, please contact jmtinfo@acmt.net.
For questions or comments about the journal, please contact jmtinfo@acmt.net.
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