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Pharmacology in Emergency Medicine| Volume 48, ISSUE 4, P458-460, April 2015

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Profound Symptomatic Bradycardia Requiring Transvenous Pacing After a Single Dose of Tizanidine

Published:November 18, 2014DOI:https://doi.org/10.1016/j.jemermed.2014.10.005
Profound Symptomatic Bradycardia Requiring Transvenous Pacing After a Single Dose of Tizanidine
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      Abstract

      Background

      We report a case of profound symptomatic bradycardia after a single dose of tizanidine.

      Case Report

      A 93-year-old female became altered and was found to have hypotension and profound symptomatic bradycardia 30 min post ingestion of a single 4-mg dose of tizanidine at her physician's office. Emergency Medical Services was called to scene and patient was transported to our tertiary medical center. In the emergency department, the patient required intubation, vasopressor support, and transcutaneous pacing. An electrocardiogram revealed atrial fibrillation with slow ventricular response with a heart rate of 19 beats/min. The patient was transferred to the intensive care unit and subsequently taken for cardiac catheterization, where a transvenous pacer was placed. During the next few days, her vital signs and mental status improved, allowing for successful extubation. Before discharge, the patient received a single-chamber pacemaker.

      Discussion

      Profound symptomatic bradycardia from a single dose of tizanidine has not been reported. A review of the patient's medications did not reveal a significant cytochrome P450 drug interaction to result in an adverse effect as previously reported in the literature.

      Conclusions

      Tizanidine should be used cautiously in elderly population and drug interactions screening should be performed.

      Keywords

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      References

      1. Tizanidine monograph. Clinical pharmacology. Gold Standard, Inc. Tampa, FL. Available at: http://www.clinicalpharmacology.com. Accessed June 26, 2013.

        View in Article
        • Kao C.
        • Chang J.
        • Chen J.
        • et al.
        Hypotension due to interaction between lisinopril and tizanidine.
        Ann Pharmacother. 2004; 38: 1840-1843
        View in Article
        • Publow S.W.
        • Branam D.L.
        Hypotension and bradycardia associated with concomitant tizanidine and lisinopril therapy.
        Am J Health Syst Pharm. 2010; 67: 1606-1610
        View in Article
        • Johnson T.R.
        • Tobias J.D.
        Hypotension following the initiation of tizanidine in a patient treated with an angiotensive converting enzyme inhibitor for chronic hypertension.
        J Child Neurol. 2000; 15: 818-819
        View in Article

      5. Drug Interactions. Micromedex 2.0. Truven Health Analytics, Inc. Greenwood Village, CO. Available at: http://www.micromedexsolutions.com. Accessed June 26, 2013.

        View in Article

      6. Drug Interaction Report. Clinical pharmacology. Gold Standard, Inc. Tampa, FL. Available at: http://www.clinicalpharmacology.com. Accessed June 26, 2013.

        View in Article

      7. Lexi-Interact Online. Lexi-Comp. Wolters Kluwer Health, Inc. Hudson, OH. Available at: http://online.lexi.com. Accessed June 26, 2013.

        View in Article
        • Naranjo C.A.
        • Busto U.
        • Sellers E.M.
        • et al.
        A method for estimating the probability of adverse drug reactions.
        Clin Pharmacol Ther. 1981; 30: 239-245
        View in Article

      Article info

      Publication history

      Published online: November 18, 2014
      Accepted: October 12, 2014
      Received in revised form: October 7, 2014
      Received: December 16, 2013

      Footnotes

      We did not submit this case report to our Institutional Review Board review as this is a single retrospective case report, which constitutes a medical educational activity and does not meet the Federal Policy for the Protection of Human Subjects definition of research.

      Identification

      DOI: https://doi.org/10.1016/j.jemermed.2014.10.005

      Copyright

      © 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.

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