Reactions 1164 - 11 Aug 2007

O SVerapamil/trandolapril overdose

Death: case reportA 57-year-old woman died after ingestion of an inadvertent

overdose of verapamil/trandolapril tablets for hypertension.The woman, whose history included diabetes mellitus with

mild chronic renal failure, received a 7-pill sample pack of aonce-daily verapamil/trandolapril 240mg/2mg combinationproduct [Tarka]. She was confused about what dosage to takeand was witnessed ingesting three pills at once, 2 days later.She was doing well for several hours but was foundunresponsive on her couch a further 12 hours later. Fourtablets were missing from the packet, but the time of theingestion of the fourth tablet was unknown.

About 48 hours after the woman’s death, an autopsyrevealed mild myocardial fibrosis, bilateral pulmonaryoedema, mild to moderate atherosclerosis of the coronaryarteries, aorta and cerebral vessels, chronic pyelonephritis andrenal arteriosclerosis. A lethal verapamil concentration of6 mg/L as well as a verapamil metabolite were detected in herheart blood. Peripheral blood could not be obtained and notesting for trandolapril concentrations was available.

Author comment: "[T]he decedent’s preexisting medicalconditions likely contributed to her death. As verapamil ismainly excreted by the kidneys, any acute or chronic renalinsufficiency may lead to decreased clearance of thedrug. . . Furthermore, the myocyte hypertrophy andinterstitial fibrosis seen in the heart possibly played a role inthe death. The likely mechanism of death in verapamiloverdoses is heart failure due to decreased myocardialcontractility and/or complete heart block."Batalis NI, et al. Verapamil toxicity - an unusual case report and review of theliterature. American Journal of Forensic Medicine and Pathology 28: 137-140, No.2, Jun 2007 - USA 801094404

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Reactions 11 Aug 2007 No. 11640114-9954/10/1164-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved