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Case Reports
. 2022 Aug;13(4):242-245.
doi: 10.14740/cr1392. Epub 2022 Aug 15.

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

Pezad Doctor  1 , William A Scott  1 , Kaitlin Tindel  2 , Hoang H Nguyen  1
Affiliations
Case Reports

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

Pezad Doctor et al. Cardiol Res. 2022 Aug.

Abstract

Ivabradine is currently approved to reduce heart rate in children with chronic heart failure and dilated cardiomyopathy. Ivabradine has also been used off-label in children to treat automatic tachyarrhythmias such as ectopic atrial tachycardia and junctional ectopic tachycardia. Adverse effects of ivabradine at physiological doses as well as its toxicity at supra-physiological doses have rarely been reported in adults. In children, weight-based dosing requires dilution of commercially available ivabradine oral solution for accuracy. We describe a case of ivabradine overdose in a newborn (treated for ectopic atrial tachycardia) secondary to inaccurate dosing leading to the infant receiving 10 times more drug than prescribed. This case highlights potential pitfalls of ivabradine prescription and preparation in children.

Keywords: Ectopic atrial tachycardia; Ivabradine toxicity; Newborn; Sinus bradycardia.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
(a) Presenting rhythm on electrocardiogram. Regular narrow complex tachycardia with visible P wave and long PR interval suggestive of ectopic atrial tachycardia. (b) Electrocardiogram on esmolol. Ectopic atrial tachycardia with variable atrioventricular conduction.
Figure 2
Figure 2
Heart rate trend after ivabradine overdose.
Figure 3
Figure 3
Electrocardiogram after overdose. Sinus bradycardia. Heart rate 70 beats per minute (bpm), PR interval 87 ms, QRS interval 59 ms, and QTc interval 454 ms.
See this image and copyright information in PMC

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