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Amphotericin-Induced Heart-Rate Decrease in Children

Division of General Pediatrics, The Hospital for Sick Children, Division of Pharmacy, The Hospital for Sick Children

Jeanette Domaratzki

Division of Pharmacy, The Hospital for Sick Children

Gideon Koren

Division of Clinical Pharmacology, The Hospital for Sick Children, Department of Pediatrics and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada

We describe six children with acute decreases in heart rate temporally related to amphotericin B administration. All patients had achieved their maximal dose within 3 to 4 days. Heart-rate drops occurred as early as day 3 but could be delayed up to day 7 after start of therapy. The mean heart rate dropped from 104 ± 8/min (range 96 to 114) to 62 ± 8/min (range 48 to 72) (P= 0.0001). A slower heart rate than baseline was noted during the entire duration of drug administration, from 60 minutes of starting the infusion to 220 minutes (mean 120 ± 40) after discontinuation of the infusion. This reaction was noted in six of 90 (6.7%) patients who had amphotericin. These six children were compared with six age-matched children who received the drug but in whom such changes in heart rate did not develop. The method of administration of amphotericin B was similar in both patients and controls, starting with 0.25 mg/kg/day and increasing by 0.25 mg/kg/day up to 1 mg/kg/day. Children with heart-rate drop received amphotericin for 4.6 ± 1.8 days, significantly shorter than their controls (12.6 ± 6.9 days) (P= 0.02), suggesting that this adverse effect has led to early discontinuation of amphotericin therapy. Physicians and nurses caring for children receiving amphotericin B should be aware of this potential adverse effect, which can be serious in a patient with an underlying heart condition or in a patient who is already on heart-rate-lowering drugs.

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