Key result
Hydroxyzine sedation linked to torsade de pointes and severe QT prolongation in complete AV block.
Case Report (n=1)
No
Even a small dose of hydroxyzine can cause significant QT prolongation and torsade de pointes in elderly patients with bradycardia, highlighting the need for extreme caution when using it for sedation in this population.
An 82-year-old woman was admitted to our hospital because of dyspnea and bradycardia during exertion. Electrocardiography revealed complete atrioventricular block. During pacemaker implantation, a small dose (12.5 mg) of hydroxyzine was injected for sedation, and torsade de pointes (Tdp) occurred. The QT interval was prolonged after administration of hydroxyzine, and Tdp was observed after the R on T phenomenon occurred, indicating that hydroxyzine was capable of prolonging the QT interval and causing Tdp. Therefore, we must be cautious when administering hydroxyzine for sedation during surgery, especially in patients with bradycardia.
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Koshino et al. (2021) conducted a case report in Complete atrioventricular block (n=1). Hydroxyzine was evaluated on Development of Torsade de Pointes and QT prolongation. Administration of 12.5 mg of hydroxyzine for sedation in an 82-year-old woman with complete atrioventricular block prolonged the QT interval to 636 ms and induced torsade de pointes.
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