Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine

Citation
Alp. Ribeiro et al., Electrocardiographic changes during low-dose, short-term therapy of cutaneous leishmaniasis with the pentavalent antimonial meglumine, BRAZ J MED, 32(3), 1999, pp. 297-301
Citations number
15
Categorie Soggetti
Medical Research General Topics
Journal title
BRAZILIAN JOURNAL OF MEDICAL AND BIOLOGICAL RESEARCH
ISSN journal
0100879X → ACNP
Volume
32
Issue
3
Year of publication
1999
Pages
297 - 301
Database
ISI
SICI code
0100-879X(199903)32:3<297:ECDLST>2.0.ZU;2-E
Abstract
The pentavalent antimonial (Sb5+) meglumine is the drug of choice for the t reatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxi city of high-dose, long-term Sb5+ therapy is well known, the use of low-dos e, short-term meglumine has been considered to be safe and relatively free from significant cardiac effects. In order to investigate the cardiotoxicit y of low-dose, short-term therapy with meglumine in cutaneous leishmaniasis , 62 CL patients treated with meglumine were studied. A standard ECG was ob tained before and immediately after the first cycle of treatment(15 mg Sb5 kg(-1) day(-1)). The electrocardiographic interpretation was carried out b lindly by two investigators using the Minnesota Code. There were no signifi cant differences in qualitative ECG variables before and after meglumine tr eatment. However, the corrected QT interval was clearly prolonged after ant imonial 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 toxic ity induced by short-term, low-dose antimonial therapy has potentially impo rtant clinical implications. Since sudden death has been related to QTc pro longation over 500 ms induced by high-dose antimonial therapy, routine elec trocardiographic monitoring is probably indicated even in CL patients treat ed with short-term, low-dose meglumine schedules. Until further studies are conducted to establish the interactions between pentavalent antimonials an d other drugs, special care is recommended when using meglumine in combinat ion with other medications, in particular with drugs that also increase the QTc interval.