Lacosamide 정맥 주사 후 발생한 심박동 및 심전도 이상 발생 분석 (Analysis of Cardiac Rhythm and Conduction Abnormalities Associated with Intravenous Lacosamide Administration)

서지정보

· 발행기관 : 한국병원약사회
· 수록지 정보 : 병원약사회지 / 40권 / 4호 / 433 ~ 448페이지
· 저자명 : 김민경, 김건희, 조정원, 최경숙, 이정화, 이주연, 김은경

초록

Background : Cardiac rhythm and conduction abnormalities related to lacosamide are described in the approved package insert. However, reports of the safety issues related to intravenous lacosamide are scarce in clinical practice. Therefore, this study aimed to describe the prevalence of cardiac rhythm and conduction abnormalities and evaluate factors associated with safety outcomes after intravenous lacosamide administration.
Methods : We reviewed the electronic medical records of all prescriptions for patients over the age of 16 years old who received intravenous lacosamide at the Seoul National University Bundang Hospital from June 2019 and May 2022. Demographic characteristics and information related to dosage, purpose, and concomitant medications were collected. Heart rates, electrocardiography (ECG) findings, and PR intervals were compared before and after lacosamide administration to evaluate cardiac rhythm and conduction abnormalities.
Results : A total of 317 prescriptions were identified. The average age of the patients was 56.3 years (SD 18.1) and 50.2% were male. The prevalence of bradycardia and ECG abnormalities was 5.6% and 6.3%, respectively. Of the 70 prescriptions having records of PR intervals before and after lacosamide administration, the rate of PR prolongation was 12.9%. Heart rate was significantly decreased (from 76.3 beats/min to 62.8 beats/min) and PR intervals were increased (from 162.5 ms to 171.8 ms) after lacosamide administration. Findings from the multivariate logistic regression analysis showed that underlying heart disease (adjusted odds ratio [ORadj]=3.22, 95% CI 1.11-9.23), concomitant prescription for lorazepam (ORadj= 3.25, 95% CI 1.44-7.56), and concomitant prescription for valproate (ORadj=3.11, 95% CI 1.35-7.20) were predictive factors of cardiac rhythm and conduction abnormalities.
Conclusion : Cardiac rhythm and conduction abnormalities were observed after intravenous lacosamide administration. Underlying heart disease and concomitant medications were associated with safety outcomes. A larger scale study is needed to confirm the cardiac rhythm and conduction abnormalities found in this study.

영어초록

Background : Cardiac rhythm and conduction abnormalities related to lacosamide are described in the approved package insert. However, reports of the safety issues related to intravenous lacosamide are scarce in clinical practice. Therefore, this study aimed to describe the prevalence of cardiac rhythm and conduction abnormalities and evaluate factors associated with safety outcomes after intravenous lacosamide administration.
Methods : We reviewed the electronic medical records of all prescriptions for patients over the age of 16 years old who received intravenous lacosamide at the Seoul National University Bundang Hospital from June 2019 and May 2022. Demographic characteristics and information related to dosage, purpose, and concomitant medications were collected. Heart rates, electrocardiography (ECG) findings, and PR intervals were compared before and after lacosamide administration to evaluate cardiac rhythm and conduction abnormalities.
Results : A total of 317 prescriptions were identified. The average age of the patients was 56.3 years (SD 18.1) and 50.2% were male. The prevalence of bradycardia and ECG abnormalities was 5.6% and 6.3%, respectively. Of the 70 prescriptions having records of PR intervals before and after lacosamide administration, the rate of PR prolongation was 12.9%. Heart rate was significantly decreased (from 76.3 beats/min to 62.8 beats/min) and PR intervals were increased (from 162.5 ms to 171.8 ms) after lacosamide administration. Findings from the multivariate logistic regression analysis showed that underlying heart disease (adjusted odds ratio [ORadj]=3.22, 95% CI 1.11-9.23), concomitant prescription for lorazepam (ORadj= 3.25, 95% CI 1.44-7.56), and concomitant prescription for valproate (ORadj=3.11, 95% CI 1.35-7.20) were predictive factors of cardiac rhythm and conduction abnormalities.
Conclusion : Cardiac rhythm and conduction abnormalities were observed after intravenous lacosamide administration. Underlying heart disease and concomitant medications were associated with safety outcomes. A larger scale study is needed to confirm the cardiac rhythm and conduction abnormalities found in this study.

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