Version 1
: Received: 12 March 2024 / Approved: 18 March 2024 / Online: 18 March 2024 (14:27:39 CET)
How to cite:
Nawa, H.; Yoshimura, Y.; Nodagashira, T. Cibenzoline Succinate Poisoning and Cardiac Arrest Treated with Venoarterial Extracorporeal Membrane Oxygenation after Small Overdose: A Case Report. Preprints2024, 2024031054. https://doi.org/10.20944/preprints202403.1054.v1
Nawa, H.; Yoshimura, Y.; Nodagashira, T. Cibenzoline Succinate Poisoning and Cardiac Arrest Treated with Venoarterial Extracorporeal Membrane Oxygenation after Small Overdose: A Case Report. Preprints 2024, 2024031054. https://doi.org/10.20944/preprints202403.1054.v1
Nawa, H.; Yoshimura, Y.; Nodagashira, T. Cibenzoline Succinate Poisoning and Cardiac Arrest Treated with Venoarterial Extracorporeal Membrane Oxygenation after Small Overdose: A Case Report. Preprints2024, 2024031054. https://doi.org/10.20944/preprints202403.1054.v1
APA Style
Nawa, H., Yoshimura, Y., & Nodagashira, T. (2024). Cibenzoline Succinate Poisoning and Cardiac Arrest Treated with Venoarterial Extracorporeal Membrane Oxygenation after Small Overdose: A Case Report. Preprints. https://doi.org/10.20944/preprints202403.1054.v1
Chicago/Turabian Style
Nawa, H., Yuya Yoshimura and Tatsuya Nodagashira. 2024 "Cibenzoline Succinate Poisoning and Cardiac Arrest Treated with Venoarterial Extracorporeal Membrane Oxygenation after Small Overdose: A Case Report" Preprints. https://doi.org/10.20944/preprints202403.1054.v1
Abstract
Introduction: Atrial fibrillation (AF) is a common cardiac arrhythmia whose prevalence rises with age and is linked to increased morbidity and mortality due to the risk of thromboembolism. Management typically involves anticoagulation and rhythm control, but the treatment of elderly patients with multiple comorbidities requires careful consideration of drug side effects and interactions. Cibenzoline, a Vaughan-Williams class IA antiarrhythmic, is effective against AF but has risks of toxicity, especially in older people and those with renal impairment, due to its renal excretion and prolonged half-life in these populations. Discussion: This paper presents a case of an 80-year-old woman with paroxysmal AF who suffered cardiac arrest due to cibenzoline toxicity despite receiving standard adjusted dosages. The patient's cibenzoline blood concentration was significantly higher than the therapeutic range, leading to cardiotoxicity, which was exacerbated by drug interactions with bisoprolol and edoxaban, both metabolized by the CYP3A4 enzyme. Venoarterial extracorporeal membrane oxygenation (V-A ECMO) and intra-aortic balloon pump (IABP) successfully managed the cardiac arrest. This case emphasizes the unpredictable pharmacokinetics of cibenzoline in elderly patients with renal impairment and the need for vigilant therapeutic drug monitoring to avoid adverse events. Conclusions: Cibenzoline can pose a significant risk of severe toxicity in elderly patients with renal impairment, and drug interactions may potentiate this risk. The paper underscores the importance of careful dose adjustment and monitoring of drug levels in this population. In cases of cibenzoline-induced cardiac arrest, V-A ECMO and IABP are effective treatment modalities. The case study serves as a critical reminder for clinicians to remain vigilant for drug-induced complications and to apply aggressive supportive treatments when necessary.
Keywords
cibenzoline succinate; drug toxicity; drug interaction; Extracorporeal Membrane Oxygenation
Subject
Medicine and Pharmacology, Emergency Medicine
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
