Bradycardia Shock Caused by the Combined Use of Carteolol Eye Drops and Verapamil in an Elderly Patient with Atrial Fibrillation and Chronic Kidney Disease

Intern Med. 2021 Jan 1;60(1):79-83. doi: 10.2169/internalmedicine.5598-20. Epub 2020 Aug 22.

Abstract

Ophthalmic carteolol is often used to treat glaucoma. Elderly patients with atrial fibrillation (AF) and chronic kidney disease (CKD) are common among the super-elderly in Japan. Because these patients are exposed to polypharmacy, they are at a high-risk of adverse drug interactions. We herein report an elderly patient with CKD who suffered bradycardia shock after the combined use of carteolol eye drops and verapamil for glaucoma and paroxysmal AF. This case highlights the fact that eye drops have a similar systemic effect to oral drugs, and especially in elderly patients with polypharmacy, drug interactions can unwittingly lead to serious events.

Keywords: carteolol; chronic kidney disease; eye drops; hyperkalemia; verapamil.

MeSH terms

  • Aged
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / drug therapy
  • Bradycardia / chemically induced
  • Carteolol*
  • Humans
  • Japan
  • Ophthalmic Solutions / adverse effects
  • Renal Insufficiency, Chronic* / complications
  • Verapamil / adverse effects

Substances

  • Ophthalmic Solutions
  • Carteolol
  • Verapamil