DOI: 10.12890/2020_001879

First-Degree Atrioventricular Block with Tachycardia from Paliperidone and Mirtazapine Overdose

Authors

  • Brian Cheung Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA; St. Bernards Healthcare, Jonesboro, Arkansas, USA
  • Chris Levy Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
  • Abhijit Shivkumar St. Bernards Healthcare, Jonesboro, Arkansas, USA

christopher.levy@med.wmich.edu

Keywords

Atrioventricular block, paliperidone

Abstract

Background: Paliperidone and mirtazapine are psychotropic agents associated with proarrhythmic effects. 
Case Presentation: A 21-year-old woman was admitted to the intensive care unit on two separate occasions for attempting suicide by overdosing on paliperidone and mirtazapine. During both admissions, the patient had atypical chest pain and a first-degree atrioventricular block (AVB) with paradoxical sinus tachycardia, which resolved with the discontinuation of paliperidone and mirtazapine and aggressive intravenous fluids.
Conclusion: Drug-induced first-degree AVB from paliperidone and mirtazapine should be on the differential diagnosis in patients on paliperidone and/or mirtazapine who present with chest pain, tachycardia or new-onset first-degree AVB

View the entire article

Downloads

References

  1. Urichuk L, Prior TI, Dursun S, Baker G. Metabolism of atypical antipsychotics: involvement of cytochrome p450 enzymes and relevance for drug-drug interactions. Curr Drug Metab 2008;9:410–418.
  2. Sherwin CMT, Saldaña SN, Bies RR, Aman MG, Vinks AA. Population pharmacokinetic modeling of risperidone and 9-hydroxyrisperidone to estimate CYP2D6 subpopulations in children and adolescents. Ther Drug Monit 2012;34:535–544.
  3. Nada A, Gintant GA, Kleiman R, Gutstein DE, Gottfridsson C, Michelson EL, et al. The evaluation and management of drug effects on cardiac conduction (PR and QRS intervals) in clinical development. Am Heart J 2013;165:489–500.
  4. Kerr GW, McGuffie AC, Wilkie S. Tricyclic antidepressant overdose: a review. Emerg Med J 2001;18:236–241.
  5. Davidson M, Emsley R, Kramer M, Ford L, Pan G, Lim P, et al. Efficacy, safety and early response of paliperidone extended-release tablets (paliperidone ER): results of a 6-week, randomized, placebo-controlled study. Schizophr Res 2007;93:117–130.
  6. Yasin M, Lateef N, Pervaiz MH. Paliperidone-associated atrioventricular block. Am J Ther 2018;25:e730–732.
  7. Hagiwara M, Kambayashi R, Aimoto M, Nagasawa Y, Takahara A. In vivo analysis of torsadogenic potential of an antipsychotic drug paliperidone using the acute atrioventricular block rabbit as a proarrhythmia model. J Pharmacol Sci 2016;132:48–54.
  8. Aro AL, Anttonen O, Kerola T, Junttila MJ, Tikkanen JT, Rissanen HA, et al. Prognostic significance of prolonged PR interval in the general population. Eur Heart J 2014;35:123–129.

Published

2020-09-29

Issue

Vol. 7 No. 12 (2020)

How to Cite

1.
Cheung B, Levy C, Shivkumar A. First-Degree Atrioventricular Block with Tachycardia from Paliperidone and Mirtazapine Overdose. EJCRIM [Internet]. 2020 Sep. 29 [cited 2026 Nov. 3];7(12). Available from: https://ejcrim.com/index.php/ejcrim/article/view/1879

Most read articles by the same author(s)