Over the Counter Drugs and Long QT Syndrome: Near Lethal Syncope after Cold Relief by Phenylephrine

Giuseppe Di Stolfo, Sandra

Abstract

Introduction: Purpose of this manuscript is a careful reconsideration concerning advantage and risk of selfmedication by Over the Counter (OTC) drugs, in relationship to QTc prolongation, unrevealing concealed QT syndrome and Sudden Arrhythmia Deaths Syndrome (SADS). Case presentation: A 64-year old lady was carried to the Emergency Department after traumatic syncope. The patient was found at home with a bruised occipital wound and retrograde amnesia; in the previous two day she had a common cold and bought an OTC (Over the Counter) formulation composed by paracetamol, ascorbic acid and phenylephrine cloridrate. ECG showed ventricular repolarization abnormality compatible with induced long QT syndrome. In the subsequent days, as phenylephrine was withdrawn, we observed a constant reduction of QT, yet still a long QTc. On the basis of clear syncope and Long QT syndrome unrevealed by phenylephrine treatment, ICD was implanted. Conclusion: Widespread self-medication for cold relief is usually perceived as safe treatment by general population; nevertheless, in some OTC, patient could encounter medicament belonging to specific “drug to avoid list” for SADS, leading to harmful impact on prognosis.