Bradycardia and hypotension associated with fomepizole infusion during hemodialysis

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 2008-07, Vol.46 (6), p.570-573
• Main Authors: LEPIK, Katherine J, BRUBACHER, Jeffrey R, DEWITT, Christopher R, LAM, George S. S, LAWSON, Edward J, ERHARDT, Gunnar D, PURSSELL, Roy A, KENNEDY, James R, BRIGNALL, Jane L
• Format: Article
• Language: English
• Subjects: Acidosis - complications; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antidotes - administration & dosage; Antidotes - adverse effects; Antidotes - therapeutic use; Biological and medical sciences; Blood Pressure - drug effects; Bradycardia - chemically induced; Cardiac dysrhythmias; Cardiology. Vascular system; Chemical and industrial products toxicology. Toxic occupational diseases; Dose-Response Relationship, Drug; Emergency and intensive care: renal failure. Dialysis management; Ethylene Glycol - poisoning; Heart; Heart Rate - drug effects; Humans; Hypotension - chemically induced; Infusions, Intravenous; Intensive care medicine; Male; Medical sciences; Middle Aged; Pyrazoles - administration & dosage; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Renal Dialysis; Solvents; Toxicology
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650701725128

We report a case of hypotension and bradycardia associated with intravenous fomepizole infusion. A 59-year-old man presented to hospital 10 hours after ethylene glycol ingestion with ataxia, slurred speech, metabolic acidosis, heart rate 70/min, blood pressure 160/100 mmHg. Treatment with hemodialysis and fomepizole began 7.5 hours after admission. Severe bradycardia (29/min) and hypotension (69 mmHg systolic) occurred immediately following a 30 minute intravenous infusion of the first (19 mg/kg) fomepizole dose, but rapidly corrected with 1 mg atropine. Transient bradycardia (48/min) and hypotension (89/57 mmHg) recurred immediately after the second (10 mg/kg) fomepizole dose, also given during dialysis. Hemodialysis may cause a drop in blood pressure and heart rate; however, the close temporal relationship with fomepizole infusions, dose-related symptom intensity and recurrence with rechallenge suggest a causal relationship with fomepizole. Hemodialysis, acidosis and high initial fomepizole dose may have enhanced patient susceptibility, as a post-dialysis fomepizole dose was well tolerated. Fomepizole may precipitate bradycardia and/or hypotension during hemodialysis. Monitor vital signs closely during and immediately after infusion.