Abstract
We report an 82-year-old man who developed ventricular tachycardia and Torsades de Pointes (TdP) after oral administration of garenoxacin, a novel quinolone antibiotic agent that differs from the third-generation quinolones, for pneumonia. He had hypokalemia (K 2.3 mmol/L) induced by licorice and also had received disopyramide for arrhythmia, bicalutamide for prostate cancer, and silodosin for prostate hypertrophy. After taking him off all drugs and administering spironolactone supplemented with potassium, his low serum potassium level was ameliorated. Therefore, although garenoxacin reportedly causes fewer adverse reactions for cardiac rhythms than third-generation quinolone antibiotics, one must be cautious of the interference of other drugs during hypokalemia in order to prevent TdP.
References
Rodent DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013–22.
Akita M, Shibazaki Y, Izumi M, Hiratsuka K, Sakai T, Kurosawa T, et al. Comparative assessment of prulifloxacin, sparfloxacin, gatifloxacin and levofloxacin in the rabbit model of proarrhythmia. J Toxicol Sci. 2004;29:63–71.
Hayashi Y, Ikeda U, Hashimoto T, Watanabe T, Mitsuhashi T, Shimada K. Torsades de Pointes ventricular tachycardia induced by clarithromycin and disopyramide in the presence of hypokalemia. PACE. 1999;22:672–4.
Walker BR, Edwards CR. Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess. Endocrinol Metabol Clin North Am. 1994;23:359–77.
Kato H, Kanaoka M, Yano S, Kobayashi M. 3-Monoglucuronyl-glycyrrhetinic acid is a major metabolite that causes licorice-induced pseudoaldosteronism. J Clin Endocrinol Metab. 1995;80:1929–33.
Homma M, Ishihara M, Qian W, Kohda Y. Effects of long term administration of Shakuyaku-kanzo-To and Shosaiko-To on serum potassium levels. Yakugaku Zasshi. 2006;126:973–8. (Japanese, English abstract).
Eriksson JW, Carlberg B, Hillorn V. Life-threatening ventricular tachycardia due to liquorice-induced hypokalemia. J Intern Med. 1999;245:307–10.
Gerritsen KGF, Meulenbelt J, Spiering W, Kema IP, Demir A, van Driel VJHM. An unusual cause of ventricular fibrillation. Lancet 2009;373:1144.
Task Force of the Working Group on Arrhythmias of the European Society of Cardiology. The Sicilian gambit. A new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. Circulation 1991;8:1831–51.
Redfern WS, Carlsson L, Davis AS, Lynch WG, MacKenzie I, Palethorpe S, et al. Relationships between preclinical cardiac electrophysiology, clinical QT interval prolongation and torsade de pointes for a broad range of drugs: evidence for a provisional safety margin in drug development. Cardiovasc Res. 2003;58:32–45.
Hayakawa H, Fukushima Y, Kato H, Fukumoto H, Kadota T, Yamamoto H, et al. Metabolism and disposition of novel des-fluoro quinolone garenoxacin in experimental animals and an interspecies scaling of pharmacokinetic parameters. DMD. 2003;31:1409–18.
Gajjar DA, Bello A, Ge Z, Christopher L, Grasela DM. Multiple-dose safety and pharmacokinetics of oral garenoxacin in healthy subjects. Antimicrob Agents Chemother. 2003;47:2256–63.
Acknowledgments
This work was supported by a grant (to HI) from the Progressive Renal Diseases Research Project of the Ministry of Health, Labour and Welfare of Japan.
Conflict of interest statement
None declared.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Miyamoto, K., Kawai, H., Aoyama, R. et al. Torsades de Pointes induced by a combination of garenoxacin and disopyramide and other cytochrome P450, family 3, subfamily A polypeptide-4-influencing drugs during hypokalemia due to licorice. Clin Exp Nephrol 14, 164–167 (2010). https://doi.org/10.1007/s10157-009-0244-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10157-009-0244-9