Flecainide toxicity associated with the use of goji berries: a case report - PubMed (original) (raw)

Case Reports

. 2021 Jun 1;5(6):ytab204.

doi: 10.1093/ehjcr/ytab204. eCollection 2021 Jun.

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Case Reports

Flecainide toxicity associated with the use of goji berries: a case report

Carlos E Guzmán et al. Eur Heart J Case Rep. 2021.

Abstract

Background: Goji berries (GB), usually marketed as a 'superfruit', are a widely used herbal supplement. As with other herbal remedies, the use of GB might be associated with herb-drug interactions, increasing plasma levels of other drugs and causing adverse events. Here, we present the case of a patient that developed flecainide toxicity secondary to an herb-drug interaction, associated with the use of GB to prevent COVID-19.

Case summary: A 75-year-old female presented to the emergency department with fainting. She was taking flecainide for the treatment of atrial extrasystoles diagnosed 2 years previously, and she was using a tea of GB for the prevention of COVID-19. The admission electrocardiogram showed a wide complex polymorphic tachycardia that was considered and treated as flecainide toxicity. The patient had a favourable evolution and was discharged 48 h after admission.

Discussion: Flecainide toxicity is uncommon and needs timely recognition and treatment; it is usually secondary to overdose and renal or hepatic failure. In our case, toxicity was associated with GB use, probably by inhibition of CYP2D6 which is the main enzyme associated with the metabolism of flecainide. Clinicians need to be aware of the possible interactions between herbal remedies (in this case used for the prevention of COVID-19) and cardiovascular drugs that are used to treat chronic cardiovascular diseases.

Keywords: COVID-19; Case report; Flecainide toxicity; Goji berries; Herb–drug interaction; SARS-CoV-2.

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.

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Figures

Figure 1.

Figure 1.

Twelve-lead electrocardiogram on admission. A 12-lead electrocardiogram obtained during admission shows a wide complex tachycardia with a heart rate of 160 b.p.m., with a polymorphic QRS complex and progressive widening of QRS in cycles of 5, 7, and 9 beats with a p-wave like deflection (*) between each cycle.

Figure 2.

Figure 2.

Rhythm strips showing electrocardiographic evolution. (A) Shows the rhythm strip of the electrocardiogram during admission. (B) A wide complex, monomorphic tachycardia that appeared after treatment with 8.4% bicarbonate infusion, the arrow indicates the moment when synchronized cardioversion was administrated because of haemodynamic instability. (C) An atypical atrial flutter appearing after electric cardioversion. (D) A repeated electrocardiogram showing persistence of the atypical flutter with a narrow QRS complex and prolonged QTc interval. (E) A pre-discharge electrocardiogram obtained 48 h. after admission shows a sinus rhythm with atrial extrasystoles and resolution of abnormalities associated with flecainide toxicity.

Figure 3.

Figure 3.

Twelve-lead electrocardiogram showing electrocardiographic evolution. (A) Twelve-lead electrocardiogram showing an atypical atrial flutter with wide complex QRS appearing immediately after synchronized cardioversion. (B) A repeated 12-lead electrocardiogram showing persistence of atypical atrial flutter now with narrow QRS complex. (C) A pre-discharge 12 electrocardiogram showing resolution of the electrocardiogram abnormalities, with a sinus rhythm and atrial extrasystoles.

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