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Successful Treatment of Propafenone, Digoxin and Warfarin Overdosage with Plasma Exchange Therapy and Rifampicin

Clinical Drug Investigation volume 27, pages 505–508 (2007)Cite this article

Abstract

We report here the successful treatment of a 16-year-old female who ingested 20 tablets of digoxin each containing 0.25mg (total dose ingested equivalent to 0.1 mg/kg), 32 tablets of warfarin each containing 5mg (equivalent to 3.2 mg/kg), and approximately 15 tablets of propafenone each containing 300mg (equivalent to 90 mg/kg). The patient developed hypotension and sinus bradycardia necessitating external cardiac pacing 17 hours after drug ingestion. In addition to gastric lavage, activated charcoal, blood alkalinisation, administration of vitamin K and temporary cardiac pacing, the authors performed plasma exchange for drug removal and administered rifampicin in order to increase the metabolism of digoxin, propafenone and warfarin. The patient was discharged without any sequelae. Plasma exchange may be lifesaving in drug ingestions where there is a low volume of distribution and high plasma protein binding. Rifampicin, an inducer of cytochrome p450, may be used in intoxications for elimination of drugs with inactive metabolites.

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Acknowledgements

No sources of funding were used to assist in the preparation of this report. The authors have no conflicts of interest that are directly relevant to the content of this report.

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Affiliations

  1. Department of Pediatrics, Division of Pediatric Hematology, Hacettepe University, Faculty of Medicine, Ankara, Turkey

    Sule Unal

  2. Department of Pediatrics, Division of Pediatric Intensive Care, Hacettepe University, Faculty of Medicine, Ankara, Turkey

    Benan Bayrakci

  3. Department of Pharmacology, Hacettepe University, Faculty of Medicine, Ankara, Turkey

    Umit Yasar

  4. Department of Pediatrics, Division of Pediatric Cardiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey

    Tevfik Karagoz

Authors
  1. Sule Unal
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  2. Benan Bayrakci
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  3. Umit Yasar
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  4. Tevfik Karagoz
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Correspondence to Sule Unal.

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Unal, S., Bayrakci, B., Yasar, U. et al. Successful Treatment of Propafenone, Digoxin and Warfarin Overdosage with Plasma Exchange Therapy and Rifampicin. Clin. Drug Investig. 27, 505–508 (2007). https://doi.org/10.2165/00044011-200727070-00008

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  • DOI: https://doi.org/10.2165/00044011-200727070-00008

Keywords

  • Warfarin
  • Digoxin
  • Rifampicin
  • International Normalise Ratio
  • Plasma Exchange