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Nicorandil and ranolazine overdose management
  1. Aziza Rashid1,
  2. Guilherme Movio2 and
  3. Gemma Claire Lee1
  1. 1Intensive Care, Blackpool Fylde and Wyre Hospitals NHS Foundation Trust, Blackpool, UK
  2. 2School of Medicine, Lancaster University, Lancaster, UK
  1. Correspondence to Dr Gemma Claire Lee; gemma.lee9{at}nhs.net

Abstract

A man in his 60s was admitted to the emergency department with chest pain following an intentional overdose of nicorandil and ranolazine. He was known to have an extensive cardiac history and had taken his prescribed medication with suicidal ideation. On presentation, he was hypotensive with a blood pressure of 70/50 mm Hg despite fluid resuscitation. He was commenced on vasopressor support and transferred to the intensive care unit. Despite an adequate blood pressure on vasopressors, he suffered a ventricular fibrillation cardiac arrest. Return of spontaneous circulation with a Glasgow Coma Score of 15 was achieved following cardiopulmonary resuscitation and three direct current shocks. Following subsequent continuous overnight significant vasopressor dependence, a dose of glucagon was given, and within 2 hours, his vasopressor requirement ceased, maintaining an unsupported normal blood pressure. He remained stable and was subsequently discharged to the coronary care unit for monitoring.

  • Cardiovascular system
  • Drug interactions
  • Poisoning
  • Adult intensive care
  • Pharmacodynamics

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Footnotes

  • Contributors GM contributed to the working and researching of content and referencing. AR contributed to the working and researching of content and referencing, GCL was the main author who contributed to all stages of the work: planning, writing, editing and submission process.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.