Cardiotoxic effect with convulsions in terfenadine overdose.

The course has been suggestive ofa hypersensitivity reaction with a shorter period to development ofabnormal liver function after re-exposure to the drug. Ours is the first case with typical pathological features of chronic active hepatitis. The evidence strongly implicated cimetidine. Inadvertent re-exposure to the drug caused rapid recurrence of jaundice and abnormal liver function values, and withdrawal of cimetidine and treatment with prednisone for two months returned these values to normal, although repeat biopsy still showed evidence of chronic active hepatitis. Pre-existing chronic active hepatitis exacerbated by cimetidine is unlikely in the absence of other recognised causes of chronic active hepatitis. This case adds to the slowly accumulating evidence implicating cimetidine as a rare but definite hepatotoxin. The low incidence makes monitoring of liver function values unlikely to be cost effective, but when clinical hepatitis occurs cimetidine must be considered a potential villain. 8QA) write: Terfenadine (Triludan) is a specific, selective, histamine HI receptor antagonist with few side effects. Four adults have developed prolonged QT intervals with doses of 120-240 mg/ day, and ventricular arrhythmias occurred 15 hours after overdose with 3 36 g in conjunction with 7 g cephalexin and 1-2 g ibuprofen. Complications were not observed in 12 other overdoses, six exceeding 1 0 g (H C Masheter, Merrrell Dow, personal communication). We report a quinidine-like effect on the myocardium with convulsions in a patient with terfenadine toxicity: A healthy 21 year old woman developed two generalised convulsions lasting two minutes 12 and nine hours before admission. There was no incontinence or tongue biting and no residual signs in the central nervous system but an irregular pulse. The patient had been given terfenadine for pruritus seven days earlier. Two tablets daily were prescribed (120 mg) but she took four tablets daily (240 mg), except for the day when the convulsions occurred, when she took none. Although 56 tablets had been prescribed only three remained in the packet; the patient claimed she had thrown the rest away. On admission there were no abnormal physical signs and blood pressure was normal. An electro-cardiogram showed prolonged QT, intervals, however, with widened notched and inverted T waves and a single premature beat. These changes remained on the second day but reverted to normal. Serial QT, intervals were: 0 57 s on day 1, 0 47 s on day 2, 0 47 s on day 3, 0 43 s on day 4, and …