Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine
The pentavalent antimonial (Sb5+) meglumine is the drug of choice for the treatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxicity of high-dose, long-term Sb5+ therapy is well known, the use of low-dose, short-term meglumine has been considered to be safe and relatively free...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Associação Brasileira de Divulgação Científica
1999-03-01
|
| Series: | Brazilian Journal of Medical and Biological Research |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X1999000300008&lng=en&tlng=en |
| _version_ | 1818020342616031232 |
|---|---|
| author | A.L.P. Ribeiro J.B. Drummond A.C. Volpini A.C. Andrade V.M.A. Passos |
| author_facet | A.L.P. Ribeiro J.B. Drummond A.C. Volpini A.C. Andrade V.M.A. Passos |
| author_sort | A.L.P. Ribeiro |
| collection | DOAJ |
| description | The pentavalent antimonial (Sb5+) meglumine is the drug of choice for the treatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxicity of high-dose, long-term Sb5+ therapy is well known, the use of low-dose, short-term meglumine has been considered to be safe and relatively free from significant cardiac effects. In order to investigate the cardiotoxicity of low-dose, short-term therapy with meglumine in cutaneous leishmaniasis, 62 CL patients treated with meglumine were studied. A standard ECG was obtained before and immediately after the first cycle of treatment (15 mg Sb5+ kg-1 day-1). The electrocardiographic interpretation was carried out blindly by two investigators using the Minnesota Code. There were no significant differences in qualitative ECG variables before and after meglumine treatment. However, the corrected QT interval was clearly prolonged after antimonial therapy (420.0 vs 429.3 ms, P<10-6). QTc augmentation exceeded 40 ms in 12 patients, 7 of whom developed marked QTc interval enlargement (500 ms) after meglumine therapy. This previously unrecognized cardiac toxicity induced by short-term, low-dose antimonial therapy has potentially important clinical implications. Since sudden death has been related to QTc prolongation over 500 ms induced by high-dose antimonial therapy, routine electrocardiographic monitoring is probably indicated even in CL patients treated with short-term, low-dose meglumine schedules. Until further studies are conducted to establish the interactions between pentavalent antimonials and other drugs, special care is recommended when using meglumine in combination with other medications, in particular with drugs that also increase the QTc interval. |
| first_indexed | 2024-04-14T08:03:49Z |
| format | Article |
| id | doaj.art-f24870fa14524a35a8fe27f5b0dceacc |
| institution | Directory Open Access Journal |
| issn | 1414-431X |
| language | English |
| last_indexed | 2024-04-14T08:03:49Z |
| publishDate | 1999-03-01 |
| publisher | Associação Brasileira de Divulgação Científica |
| record_format | Article |
| series | Brazilian Journal of Medical and Biological Research |
| spelling | doaj.art-f24870fa14524a35a8fe27f5b0dceacc2022-12-22T02:04:49ZengAssociação Brasileira de Divulgação CientíficaBrazilian Journal of Medical and Biological Research1414-431X1999-03-0132329730110.1590/S0100-879X1999000300008S0100-879X1999000300008Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumineA.L.P. Ribeiro0J.B. Drummond1A.C. Volpini2A.C. Andrade3V.M.A. Passos4Universidade Federal de Minas GeraisUniversidade Federal de Minas GeraisFIOCRUZFIOCRUZUniversidade Federal de Minas GeraisThe pentavalent antimonial (Sb5+) meglumine is the drug of choice for the treatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxicity of high-dose, long-term Sb5+ therapy is well known, the use of low-dose, short-term meglumine has been considered to be safe and relatively free from significant cardiac effects. In order to investigate the cardiotoxicity of low-dose, short-term therapy with meglumine in cutaneous leishmaniasis, 62 CL patients treated with meglumine were studied. A standard ECG was obtained before and immediately after the first cycle of treatment (15 mg Sb5+ kg-1 day-1). The electrocardiographic interpretation was carried out blindly by two investigators using the Minnesota Code. There were no significant differences in qualitative ECG variables before and after meglumine treatment. However, the corrected QT interval was clearly prolonged after antimonial therapy (420.0 vs 429.3 ms, P<10-6). QTc augmentation exceeded 40 ms in 12 patients, 7 of whom developed marked QTc interval enlargement (500 ms) after meglumine therapy. This previously unrecognized cardiac toxicity induced by short-term, low-dose antimonial therapy has potentially important clinical implications. Since sudden death has been related to QTc prolongation over 500 ms induced by high-dose antimonial therapy, routine electrocardiographic monitoring is probably indicated even in CL patients treated with short-term, low-dose meglumine schedules. Until further studies are conducted to establish the interactions between pentavalent antimonials and other drugs, special care is recommended when using meglumine in combination with other medications, in particular with drugs that also increase the QTc interval.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X1999000300008&lng=en&tlng=encutaneous leishmaniasiselectrocardiographyQT interval |
| spellingShingle | A.L.P. Ribeiro J.B. Drummond A.C. Volpini A.C. Andrade V.M.A. Passos Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine Brazilian Journal of Medical and Biological Research cutaneous leishmaniasis electrocardiography QT interval |
| title | Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine |
| title_full | Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine |
| title_fullStr | Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine |
| title_full_unstemmed | Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine |
| title_short | Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine |
| title_sort | electrocardiographic changes during low dose short term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine |
| topic | cutaneous leishmaniasis electrocardiography QT interval |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X1999000300008&lng=en&tlng=en |
| work_keys_str_mv | AT alpribeiro electrocardiographicchangesduringlowdoseshorttermtherapyofcutaneousleishmaniasiswiththepentavalentantimonialmeglumine AT jbdrummond electrocardiographicchangesduringlowdoseshorttermtherapyofcutaneousleishmaniasiswiththepentavalentantimonialmeglumine AT acvolpini electrocardiographicchangesduringlowdoseshorttermtherapyofcutaneousleishmaniasiswiththepentavalentantimonialmeglumine AT acandrade electrocardiographicchangesduringlowdoseshorttermtherapyofcutaneousleishmaniasiswiththepentavalentantimonialmeglumine AT vmapassos electrocardiographicchangesduringlowdoseshorttermtherapyofcutaneousleishmaniasiswiththepentavalentantimonialmeglumine |