[No Title Available]

Abstract

The pentavalent antimonial (Sb 5+ ) meglumine is the drug of choice for the treatment of cutaneous leishmaniasis (CL) in Brazil. Although the cardiotoxicity of high-dose, long-term Sb 5+ therapy is well known, the use of low-dose, short-term meglumine has been considered to be safe and relatively free from significant cardiac effects. In order to investigate the cardiotoxicity of low-dose, short-term therapy with meglumine in cutaneous leishmaniasis, 62 CL patients treated with meglumine were studied. A standard ECG was obtained before and immediately after the first cycle of treatment (15 mg Sb 5+ kg -1 day -1 ). The electrocardiographic interpretation was carried out blindly by two investigators using the Minnesota Code. There were no significant differences in qualitative ECG variables before and after meglumine treatment. However, the corrected QT interval was clearly prolonged after antimonial therapy (420.0 vs 429.3 ms, P<10 -6 ). QTc augmentation exceeded 40 ms in 12 patients, 7 of whom developed marked QTc interval enlargement (500 ms) after meglumine therapy. This previously unrecognized cardiac toxicity induced by short-term, low-dose antimonial therapy has potentially important clinical implications. Since sudden death has been related to QTc prolongation over 500 ms induced by high-dose antimonial therapy, routine electrocardiographic monitoring is probably indicated even in CL patients treated with short-term, low-dose meglumine schedules. Until further studies are conducted to establish the interactions between pentavalent antimonials and other drugs, special care is recommended when using meglumine in combination with other medications, in particular with drugs that also increase the QTc interval.

Historical Series of Patients With Visceral Leishmaniasis Treated With Meglumine Antimoniate in a Hospital for Tropical Diseases, Maceió-Al, Brazil

“…The cardiotoxicity associated with high doses and duration of treatment, is the most serious side effect with the use of Glucantime ® 23 . Other authors also suggest that it is necessary to evaluate electrocardiographic tests during treatment with pentavalent antimonials regardless of the presence of factors that increase the risk of cardiac disease 24 .…”

Topical treatment with nanoliposomal Amphotericin B reduces early lesion growth but fails to induce cure in an experimental model of cutaneous leishmaniasis caused by Leishmania mexicana

“…For the past sixty years, pentavalent antimonials have been the leading treatment for CL cases. These drugs are known to cause liver, kidney, and cardiac toxicity, and other severe side effects (Veiga et al, 1985; Ribeiro et al, 1999). Treatment with pentavalent antimonials (Pentostam™ and Glucantime™), as well as other anti-leishmanial drugs, is usually via parenteral routes, often intravenously (Croft et al, 2006; Croft and Yardley, 2002).…”