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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 12  |  Issue : 1  |  Page : 34-35

Sinus bradycardia caused by flurbiprofen intoxication


1 Department of Internal Medicine, Findikli State Hospital, Rize, Turkey
2 Department of Cardiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
3 Department of Internal Medicine, Tasliçay State Hospital, Agri, Turkey
4 Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey

Date of Web Publication5-Jan-2015

Correspondence Address:
Selcuk Yaylaci
Department of Internal Medicine, F?nd?kl? State Hospital, Rize
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-7969.148484

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  Abstract 

Flurbiprofen is a powerful nonsteroidal anti-inflammatory agent that has analgesic, anti-inflammatory, and antipyretic effects. Its most frequent side-effects are the gastrointestinal side-effects. In this study, we present a case with sinus bradycardia developed due to high-dose flurbiprofen consumption.

Keywords: Flurbiprofen, high-dose, sinus bradycardia


How to cite this article:
Yaylaci S, Kocayigit I, Genc AB, Tamer A, Gunduz H. Sinus bradycardia caused by flurbiprofen intoxication. Nig J Cardiol 2015;12:34-5

How to cite this URL:
Yaylaci S, Kocayigit I, Genc AB, Tamer A, Gunduz H. Sinus bradycardia caused by flurbiprofen intoxication. Nig J Cardiol [serial online] 2015 [cited 2020 Oct 19];12:34-5. Available from: https://www.nigjcardiol.org/text.asp?2015/12/1/34/148484


  Introduction Top


Flurbiprofen is a powerful nonsteroidal anti-inflammatory agent that has analgesic, anti-inflammatory, and antipyretic effects. Its most frequent side-effects are gastrointestinal, but rarely cardiac side-effects are also observed as in our case. In this study, we present a case with sinus bradycardia developed due to high-dose flurbiprofen consumption.


  Case report Top


A 32-year-old female patient was admitted approximately 1 h after taking drugs (flurbiprofen 100 mg, 20 pieces) to commit suicide, with nausea and vomiting symptoms. Her medical history and family history was unremarkable. On physical examination, the overall condition was well, she was conscious, arterial blood pressure: 120/70 mm/Hg, pulse: 41/min, and the body temperature was 36.2°C; the system examination was unremarkable. The patient underwent gastric lavage and carbon were administered through a nasogastric probe. Parenteral fluid therapy was applied. Laboratory investigation was unremarkable. Electrocardiogram (ECG) monitoring was initiated. Sinus bradycardia was present in the ECG [Figure 1]. Temporary pacemaker was not required because the patient was hemodynamically stable. Sinus bradycardia turned to normal sinus rhythm at the 2 nd h of the follow-up, without medication [Figure 2]. The patient recovered uneventfully and was discharged by recommending a psychiatric outpatient clinic control, after an average 24 h of follow-up.
Figure 1: Sinus bradycardia at the consultation

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Figure 2: Normal sinus rhythm on follow-up

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  Discussion Top


Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of pain and inflammation. The clinical benefit of NSAIDs leans on inhibition of the enzyme cyclo-oxygenase which is the first step in the conversion of arachidonic acid to prostaglandins, thromboxane and prostacyclins. Every component of the inflammatory process has been associated with fundamental mechanisms of arrhythmia inflammation via cytokines is known to provoke calcium channel dysfunction which has a main role on arrhythmia. Inflammatory mediators such as cytokines and reactive oxygen species which are produced by inflammatory cells may alter connexin integrity that plays an important role in gap junction and thus electrical conduction. On the other hand, NSAIDs may cause renal toxicity that could be responsible for electrolyte imbalances leading to arrhythmias. [1],[2]

Although there are cases of bradycardia induced by various drugs in the literature, [3],[4],[5],[6] bradycardia caused by flurbiprofen is very rare. [7] Only 1 (0.08%) of the 1243 reported adverse events of flurbiprofen were sinus bradycardia. [7] Although tachycardia is frequent in the high dose of the drug intake, bradycardia was detected in our case.


  Conclusion Top


Therefore, it should be kept in mind that bradycardia may also be seen in the high-dose drug consumptions, as well as tachycardia.

 
  References Top

1.
Ryu K, Li L, Khrestian CM, Matsumoto N, Sahadevan J, Ruehr ML, et al. Effects of sterile pericarditis on connexins 40 and 43 in the atria: Correlation with abnormal conduction and atrial arrhythmias. Am J Physiol Heart Circ Physiol 2007;293:H1231-41.  Back to cited text no. 1
    
2.
Zhang J, Ding EL, Song Y. Adverse effects of cyclooxygenase 2 inhibitors on renal and arrhythmia events: Meta-analysis of randomized trials. JAMA 2006;296:1619-32.  Back to cited text no. 2
    
3.
Kaur A, Yu SS, Lee AJ, Chiao TB. Thalidomide-induced sinus bradycardia. Ann Pharmacother 2003;37:1040-3.  Back to cited text no. 3
    
4.
Akikusa JD, Feldman BM, Gross GJ, Silverman ED, Schneider R. Sinus bradycardia after intravenous pulse methylprednisolone. Pediatrics 2007;119:e778-82.  Back to cited text no. 4
    
5.
Moazzam MS, Nasreen F, Bano S, Amir SH. Symptomatic sinus bradycardia: A rare adverse effect of intravenous ondansetron. Saudi J Anaesth 2011;5:96-7.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Cruz Tejedor M, Córdoba Sánchez ÁL, Morató Bellido B, Martínez Gil Í, Guerrero Sanz JE. Symptomatic sinus bradycardia induced by subcutaneous octreotide. Med Intensiva 2011;35:197-8.  Back to cited text no. 6
    
7.
Available from: http://www.ehealthme.com/ds/flurbiprofen/sinus+bradycardia. [Last accessed on 2013 Oct 30].  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]



 

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